¶Governmental beneficiaries excluded, terms and conditions apply.
*Estimated payment based on savings of up to $563 per month.
One month is defined as 28 days and 4 pens.
Three months is defined as 84 days and up to 12 pens.
Commercial insurance with coverage for Zepbound:
If you have commercial insurance with coverage for Zepbound, you may be eligible to pay as low as $25
for
a 1-month or 3-month prescription with the Zepbound Savings Card.¶†
¶For eligible, commercially insured patients with Zepbound coverage.
Governmental beneficiaries excluded. Terms and
conditions apply.
Commercial insurance without coverage for Zepbound:
If you have commercial drug insurance but it does not cover Zepbound, you may pay as low as
$550*
for a 1-month supply of Zepbound.¶†
*Estimated payment based on savings of up to $563 per month.
¶For eligible, commercially insured patients without Zepbound coverage. Governmental
beneficiaries
excluded. Terms and conditions apply.
†One month is defined as 28 days and 4 pens. Three months is defined as 84 days and up to 12
pens.
Terms and Conditions
By enrolling in the Zepbound Savings Card Program (“Program”) and using the Zepbound Savings Card
(“Card”), you
attest that you meet the eligibility criteria, and you agree to comply with the terms and conditions
described
below:
Card Eligibility:
-
You have been prescribed Zepbound consistent with FDA-approved product labeling.
- You are enrolled in a commercial drug insurance plan
-
You are not enrolled in any state, federal, or government funded healthcare program, including,
without
limitation, Medicaid, Medicare, Medicare Part D, Medicare Advantage, Medigap, DoD, VA,
TRICARE®/CHAMPUS, or any state prescription drug assistance program.
- You are a resident of the United States or Puerto Rico
- You are 18 years of age or older
Card Terms and Conditions
For patients with commercial drug insurance coverage for Zepbound: You must have commercial drug
insurance that covers Zepbound®(tirzepatide) and a prescription consistent with FDA-approved product
labeling to
pay as little as $25 for a 1-month, 2-month, or 3-month prescription fill of Zepbound. Month is defined
as
28-days and up to 4 pens. Card savings are subject to a maximum monthly savings of up to $150 per
1-month
prescription, $300 per 2-month prescription, or $450 per 3-month prescription fill and separate maximum
annual
savings of up to $1,800 per calendar year. Card may be used for a maximum of up to 13 prescription fills
per
calendar year. Participation in the Program requires a valid patient HIPAA authorization. Subject to
Lilly USA,
LLC’s (“Lilly”) right to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card
terms and
conditions which may occur at Lilly’s sole discretion, without notice, and for any reason, Card expires
and
savings end on 12/31/2024.
For patients with commercial drug insurance who do not have coverage for Zepbound:
You must have commercial drug insurance that does not cover Zepbound and a prescription consistent with
FDA-approved product labeling to obtain
savings of up to $563 off your 1-month prescription fill of Zepbound. Month is defined as 28-days and up
to 4
pens. Card savings are subject to a maximum monthly savings of up to $563 and a separate maximum annual
savings
of up to $7,319 per calendar year. Card may be used for a maximum of up to 13 prescription fills per
calendar
year. Participation in the Program requires a valid patient HIPAA authorization. Subject to Lilly’s
right to
terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions which
may occur
at Lilly’s sole discretion, without notice, and for any reason, Card expires and savings end on
12/31/2024.
Additional Terms and Conditions
If you have an insurance plan that is participating in an alternate funding program (“AFP”) (examples
include,
but are not limited to, ImpaxRX, Payer Matrix, SHARx, Script Sourcing, and Paydhealth) that requires you
to
apply to the Zepbound Savings Card Program or otherwise pursue specialty drug prescription coverage
through an
alternate funding vendor as a condition of, requirement for, or prerequisite to coverage of Zepbound,
you are
not eligible for and are prohibited from using the Zepbound Savings Card Program. AFPs include programs
where
coverage, reimbursement, or patient out of pocket costs for a product in some way vary based on the
availability
of a manufacturer co-pay program. AFPs may modify, delay, deny, restrict, or withhold insurance benefits
or
coverage from patients, or exclude Lilly products from coverage contingent upon a member’s use of
Zepbound
Savings Card Program. You agree to inform the Zepbound Savings Card Program if you are or become a
member of
such an alternative funding program. You are responsible for any applicable taxes, fees, and any amount
that
exceeds the monthly or annual maximum Card savings. Monthly and annual maximum savings are set at
Lilly’s sole
and absolute discretion and may be changed with or without notice at any time for any reason. At its
sole
discretion and with or without notice, Lilly may reduce, eliminate, or otherwise modify the Card savings
for any
reason, including but not limited to if your commercial drug insurance plan imposes additional
requirements
which limits or prevents you from receiving coverage for Zepbound, only allows partial coverage for
Zepbound,
removes coverage for Zepbound and requires you to utilize the Card, does not provide a material level of
financial assistance for the cost of Zepbound, or does not apply Card payments to satisfy your
co-payment,
deductible, or coinsurance for Zepbound. Card savings are not valid for: Massachusetts residents if an
AB-rated
generic equivalent is available; California residents if an FDA-approved therapeutic equivalent is
available.
You must meet the Card eligibility criteria, terms and conditions every time you use the Card. Card
activation
is required. No party may seek reimbursement from your health insurance, any third party, or any health
savings,
flexible spending, or other healthcare reimbursement accounts, for any amount of the savings received
through
the Card. By utilizing the Card, you agree that if you are required to do so under the terms of your
insurance
coverage for this prescription or are otherwise required to do so by law, you will notify your Insurance
Carrier
of your redemption of the Card. Card savings cannot be combined or utilized with any other program,
discount,
discount card, cash discount card, coupon, incentive, or similar offer involving Zepbound. You agree
that this
Card savings is intended solely for the benefit of you, the patient, and that the Card benefits are
nontransferable. It is prohibited for any person to sell, purchase, or trade; or to offer to sell,
purchase, or
trade, or to counterfeit the Card. The Card is not insurance. Lilly has the sole right to interpret and
apply
Card eligibility criteria, and terms and conditions. Card eligibility, and terms and conditions may be
terminated, rescinded, revoked, or amended by Lilly at any time without notice and for any reason.
Eligibility
criteria, and terms and conditions for the Zepbound Savings Card Program may change from time to time;
the most
current version can be found at
https://zepbound.lilly.com/coverage-savings. You may be required to obtain a new
Card, including if any Card terms and conditions have been terminated, rescinded, revoked, or amended by
Lilly.
Card void where prohibited by law. Subject to Lilly’s right to terminate, rescind, revoke or amend Card
eligibility criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion,
without
notice, and for any reason, the Card expires and savings end on 12/31/2024.