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

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

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[quote=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)?[/quote]

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