Does Cigna Cover Zepbound?

Cigna is a well-known insurance provider that offers a range of health insurance plans. Many individuals who are considering weight loss medications may wonder if Cigna covers Zepbound, a prescription chronic weight management medicine. In this article, we will explore the coverage of Eli Lilly’s Zepbound by Cigna and provide an overview of weight-loss medicines and their use.

What is Zepbound?

The brand name drug Zepbound is a new medication manufactured by Eli Lilly that has gained attention for its potential as a weight loss drug. It is a cutting-edge drug that has shown promising results in body weight reduction in clinical trials. Zepbound shares the same active ingredient, tirzepatide, with Mounjaro (another FDA-approved drug by Eli Lilly that treats diabetes).

Zepbound targets specific mechanisms in the body to promote weight loss and contains the same active ingredient, tirzepatide. Zepbound activates receptors of hormones secreted from the intestine, such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptides (GIP), which reduce appetite and food intake.

Zepbound is indicated for chronic weight management in adult patients with obesity with a BMI (body mass index) of 30+, or who are overweight with a BMI of 27+ with weight-related medical health conditions. Weight-related conditions may include high blood pressure (hypertension), type 2 diabetes, obstructive sleep apnea, cardiovascular disease or high cholesterol. It is typically prescribed in conjunction with a low-calorie diet and increased physical activity to help people lose weight and maintain weight loss.

Understanding weight-loss medicines

Weight loss medicines are medications that can be prescribed to individuals who are struggling with obesity or being overweight and have weight-related health conditions such as hypertension, obstructive sleep apnea or type 2 diabetes. These medicines are designed to aid in weight loss when combined with a healthy diet and exercise.

There are several weight-loss prescription drugs available on the market, and each works differently to promote weight loss. Some examples of FDA approved (Food and Drug Administration) weight-loss medicines include:

• Semaglutide (Wegovy, Ozempic)
• Liraglutide (Saxenda)
• Tirzepatide (Zepbound)
• Phentermine/topiramate (Qsymia)
• Bupropion/naltrexone (Contrave)
• Orlistat (Xenical)

Coverage of Zepbound by Cigna

Cigna’s coverage of Zepbound may vary depending on the specific health insurance plan. It is important to review the details of your plan or contact Cigna directly to determine if Zepbound is covered and to what extent. Your coverage may be influenced by factors such as medical necessity and prior authorization requirements.

To find out if Zepbound is covered by your Cigna plan, you can take the following steps:

• Review your plan: Read the details of your health insurance plan to see if it includes coverage for prescription weight-loss medicines
• Contact Cigna: Reach out to Cigna’s customer service or check their website for information on covered medications. Ask specific questions about Zepbound and its coverage under your plan
• Talk to your healthcare provider: Consult with your healthcare provider, such as your doctor or pharmacist, to discuss the best weight-loss medication options for you and to determine if Zepbound is appropriate
• Consider alternatives: If Zepbound is not covered by your Cigna plan, your healthcare provider may be able to recommend alternative weight-loss medications that are covered or explore other treatment options

Remember that coverage for weight-loss medicines may also depend on medical necessity and meeting certain criteria. Your healthcare provider can work with you to determine the most suitable treatment plan within the scope of your insurance coverage.

Weight-loss medicines and their effectiveness

The effectiveness of weight-loss medicines can vary depending on the individual and the specific medication. Different weight-loss medicines produce different results in each person. It is important to manage expectations and understand that weight-loss medicines are not a magic solution. They are intended to be used in conjunction with a healthy diet and regular exercise.

Studies have shown that weight-loss medicines can help some individuals lose a significant amount of weight. On average, individuals may be able to lose 5% to 16% or more of their body weight with the help of these medications. However, individual results can vary, and it is essential to work closely with your healthcare provider to monitor progress and adjust the treatment plan as needed.

It is important to note that weight-loss medicines are typically used as a long-term solution rather than a short-term fix. Healthy eating and an active lifestyle should be maintained even after achieving weight loss with the help of medication. Additionally, some individuals may experience weight regain if they discontinue taking the weight-loss medicine. Therefore, it is crucial to establish sustainable lifestyle habits to maintain long-term weight management.

Side effects and considerations

Like any medication, weight-loss medicines can have side effects. Common side effects of weight-loss medicines may include nausea, vomiting, headaches, and changes in bowel habits. It is important to discuss potential side effects with your healthcare provider and report any adverse reactions you experience.

Certain weight-loss medicines have specific cautions and considerations. For example, some medications may have potential effects on blood pressure or bowel habits. It is important to disclose your medical history and any pre-existing conditions to your healthcare provider before starting any weight-loss medication.

Additionally, weight-loss medicines may have interactions with other medications, vitamins, herbs, or supplements you may be taking. It is crucial to inform your healthcare provider about all the medications and supplements you are currently using to avoid any potential drug interactions.

Cost considerations and alternatives

Weight-loss medicines can vary in cost, and coverage by insurance plans may also vary. If you are considering Zepbound or any other weight-loss medication and are concerned about the cost, it is advisable to review your insurance plan and discuss options with your healthcare provider.

Some insurance plans may cover weight-loss medicines, but it is essential to understand the specifics of your coverage, such as which medications are covered and for how long. You may need to use specific pharmacies or meet certain criteria for coverage.

If your insurance plan does not cover Zepbound or the cost is a concern, your healthcare provider may be able to suggest alternative weight-loss medications that are covered by your insurance plan. They may also provide information about patient assistance programs or lower-cost medication options.

Conclusion

Determining if Cigna covers Zepbound or any other weight-loss medication requires a careful review of your specific insurance plan. It is important to understand the coverage details, potential limitations, and requirements for prior authorization. Working closely with your healthcare provider can help you navigate the process and find the most suitable weight-loss medication within the scope of your insurance coverage. Remember to always follow your healthcare provider’s guidance and maintain a healthy lifestyle to support your weight-loss journey.

Sources

• Drug and Biologic Coverage Policy
• Weight-Loss Medicines – Cigna