Zepbound: insurance coverage after reaching goal; expiration of Eli Lilly's savings card

[Anonymous]

I know this is evolving, but as I embark on using Zepbound to lose weight, these are the questions that I have. I'd be grateful for answers or just helpful thoughts/considerations.

(1) Can insurance refuse to cover Zepbound after one's BMI is below 30 (where initial approval was based on BMI of 30+) or one's BMI is below 27 (where initial approval was BMI of 27+ and a condition like hypertension)?

(2) Can provider decide that one no longer needs a prescription based on the above? If I switch providers, would they take weight history into account to prescribe Zepbound?

(3) I know that obesity is a chronic condition. If one does not have that for a year, is that no longer chronic?

(4) Current Eli Lilly savings card expires on 12/31/25, including the $349/$499 self-pay options. If Eli Lilly/FDA are successful in shutting down compounders, what's Eli Lilly's incentive to extend the savings program? Competing with Wegovy (currently covered by more insurance plans, it seems)?

[Anonymous]

Eli Lilly previously extended the savings card. They may do it again. I hope.

[Anonymous]

Go to a provider who specializes in obesity (I see Colleen Jurgens who is a NP with INOVA). They will know how to correctly write the script to maximize coverage with your carrier.

With that said, yes, it depends on how your policy is written as to whether or not they can deny coverage.

[Anonymous]

My primary care doctor prescribed Zepbound. A PA was required and it was approved.

The PA is good for one year.
I'm guessing my Dr will submit again at that point.

I just picked up my Zepbound on Sunday 8/3 at Walgreens $348.68

Good Luck!

[Anonymous]

Thanks. This is OP. My PA for Zepbound was approved. I will need to ask my prescriber for how long…

I worry about the long-term. I could previously lose weight (not easily), but it would come back every time when life gets very busy and I cannot put weight maintenance above all. I am 46 and ideally would like to be on this through menopause. Not looking for vanity loss, just want to maintain what I’d lose and stay healthy during a busy and stressful period of life.