As a result of its recent breakthrough in metabolic health, tirzepatide is now sold under two different brand names, Mounjaro for treating type 2 diabetes and Zepbound for chronic weight management. Although these medications provide amazing results for many patients, the demand for utilizing these products has been tremendous, and therefore, it is also relatively expensive. For most patients, the minimum out-of-pocket expense can be more than $1,000/month, making it very difficult for patients to be able to afford to take advantage of the benefits the product offers.
Eli Lilly has developed a variety of programs that provide patients with discounts on their medications to help reduce the overall expense of a medication. These programs will be available regardless of whether the patient has insurance coverage for their medication, has no insurance, or does not have insurance coverage through their employer. This document is designed to provide patients with an overview of the various ways they can save on medications through Eli Lilly. The various savings programs available, such as LillyDirect, savings cards, and patient assistance programs, can assist patients in securing the lowest possible price for their medications.
What is Tirzepatide & Why Cost Matters
The drug tirzepatide is an injectable medication that is thought to act as both a GIP receptor agonist (which stimulates insulin secretion in a glucose-dependent manner) and a GLP-1 receptor agonist (which has multiple effects, including reducing appetite). These hormones are produced in response to eating foods high in carbohydrates, fats, or proteins, but also when we eat carbohydrates.
- Mounjaro: FDA-approved for the treatment of type 2 diabetes.
- Zepbound: FDA-approved for chronic weight management in adults with obesity or overweight and weight-related medical problems.
The list (wholesale acquisition) price of these drugs is around $1080 – $1086 a month. Purchasing them without any form of discount or insurance coverage is, therefore, cost-prohibitive for most households. Additionally, even with insurance, many patients have to pay high co-pays because of high deductibles and/or placement as a “Tier 3” drug.
Cost Comparison Table (Estimated)
| Program Status | Estimated Monthly Cost (Zepbound) | Estimated Monthly Cost (Mounjaro) |
| No Insurance/Discount | $1,080+ | $1,080+ |
| With Savings Card (Covered) | As low as $25 | As low as $25 |
| With Savings Card (Not Covered) | ~$460-$550 | ~$500-$535 |
| With Tirzepatide Medics | $399 per month with free online consultation | $399 per month with free online consultation |
Does Eli Lilly Offer Discounts for Tirzepatide?
Yes, Eli Lilly maintains a multi-tiered affordability strategy. Depending on your insurance status and the specific brand you are prescribed, you may qualify for one of the following:
- Zepbound Savings Card: Designed for patients with commercial insurance. It offers different levels of savings depending on whether your insurance covers the drug or not.
- Mounjaro Savings Card: Similar to Zepbound, this helps type 2 diabetic patients lower their co-pays.
- Zepbound Self-Pay Journey (LillyDirect): A newer option for patients without insurance coverage, offering 2.5 mg and 5 mg single-dose vials at a reduced, transparent “cash” price.
- Lilly Cares® Foundation: A separate non-profit program that provides free medication to qualifying low-income patients who have no insurance or are underinsured.
Eligibility for Tirzepatide Discounts
Eligibility is strictly defined by federal law and Lilly’s internal policies.
Commercial Insurance Requirements
To use the Savings Cards, you must have commercial (private) insurance. This usually comes through an employer or is purchased via the Health Insurance Marketplace (ACA).
- Exclusions: You cannot use these cards if you are enrolled in any government-funded program, including Medicare, Medicaid, TRICARE, or CHAMPVA.
Self-Pay Journey (LillyDirect)
This is intended for patients who do not have insurance coverage for Zepbound or choose not to use it. It specifically focuses on the 2.5 mg and 5 mg vial options.
Lilly Cares (Patient Assistance)
- Income: Up to 300% Federal Poverty Level (FPL); U.S. resident; includes some Medicare Part D patients with no/low coverage.
- Residency: Must be a U.S. resident.
- Coverage: Generally for those with no insurance or those whose insurance specifically excludes the medication.
Step-by-Step: Apply for Tirzepatide Savings
Step 1: Check Insurance Plan Type
The number to call for any questions about your insurance coverage is located on the back of your card, or you can log into the area provided by your insurance company to ask both of these questions:
- Is Zepbound/Mounjaro listed on the formulary?
- Will it need a Prior Authorisation (PA) for me to receive coverage?
- How much will my co-pay be after I have met my deductible?
Step 2: Visit the Official Savings Page
Go directly to the manufacturer’s sites. Avoid third-party “coupon” sites that may sell your data or provide invalid codes.
- Zepbound: https://zepbound.lilly.com/savings-support
- Mounjaro: https://mounjaro.lilly.com/savings-resources
Step 3: Complete the Enrollment Form
You will be asked to attest that you have a valid prescription, are a U.S. resident, and are not on a government insurance plan. You will then provide your email to receive the digital card.
Step 4: Activate & Save Your Card
The system will generate a card containing four vital pieces of information:
- BIN
- PCN
- Group ID
- Member ID
Screenshot this or add it to your Apple/Google Wallet.
Step 5: Pharmacy Submission
When you submit your prescription, please inform the pharmacy technician that you intend to utilize the manufacturer’s card as supplemental or secondary insurance. They have to bill your initially submitted insurance before the manufacturer’s savings card is billed as a secondary source of payment. If your initial source of payment (primary insurance) denies payment, the savings card usually can still be accessed and applied towards the cost of the medication.
Step 6: Use the Self-Pay Route (Vials)
If you wish to purchase your medication at a reduced price using LillyDirect (for example, the vials at $399–$549), you will need to have your prescribing physician send your prescription directly to LillyDirect Pharmacy Solutions. You will then receive an email or text with a link that allows you to create an account with LillyDirect and pay your transparent price for the medication online.
Where & How to Use Your Tirzepatide Discount
All of the major drug store chains (CVS, Walgreens, Wal-Mart, and Rite Aid) can process these claims, but independently owned drug stores are often more willing to go through the process of working out an intricate “split-bill” claim with a customer.
Tips for Success:
- LillyDirect: This is often the smoothest path for the self-pay vial program, as the “discount” is built into the platform’s pricing.
- Processing: If the pharmacist says it “doesn’t work,” ask them to check the “Coordination of Benefits” (COB) field. Often, a specific code (like “08”) is needed to tell the system that the primary insurance denied the claim.
Typical Savings & Cost Examples
- Case A (Insurance Covers Zepbound): Your co-pay is $150. You apply the Savings Card. Your final price: $25.
- Case B (Insurance Denies Zepbound): The list price is $1,060. You apply the Savings Card for those without coverage. Your final price: ~$550.
- Case C (LillyDirect Vials): You pay out of pocket for a 2.5 mg vial. Your final price: $299.
- Case D (Lilly Cares): You meet the low-income requirements. Your final price: $0.
Common Issues & Troubleshooting
- Pharmacy says my card is invalid: Your pharmacy says that my card is not valid: Please ensure that you are using a Current Card. Lilly has a very active program and will update your card yearly, so you may need to download an updated card.
- Maximum Benefits: The cards listed on this page have a maximum benefit (i.e.,$7000 or $13000 per year). After reaching the maximum benefit, the cost of medication will revert to a regular cash price until the next calendar year.
- Refill Timing: Most cards only allow for a refill every 21-23 days. If you try to refill a medication within that time frame, your refill will be rejected with the message “Refill Too Soon”.
Tips to Maximize Savings
- Ask for a Prior Authorization (PA): If your insurance denies coverage, ask your doctor to submit a PA. If the PA is approved, your savings card benefit becomes much larger.
- Use the Vials: If you are on a maintenance dose of 2.5 mg or 5 mg, the Zepbound vials via LillyDirect are significantly cheaper than the pens if you are paying cash.
- Verify Monthly: Before heading to the pharmacy, check the Lilly website to ensure the terms of the savings card haven’t changed.
Conclusion
The expense of tirzepatide is like another job all by itself, but you can save a lot of money when you know what to do. When you understand how Savings Card, LillyDirect, and Lilly Cares work, you may be able to save thousands of dollars on your tirzepatide prescription annually. The first step is to verify your current insurance coverage, and the next step is to visit Eli Lilly’s official Sites for your Discount.
Frequently Asked Questions (FAQs)
Is it possible to utilize the savings card in the absence of insurance?
Savings cards are offered to those who have a commercial insurance policy currently in place. Although a covered medication may not be covered by an individual’s policy, the discount cannot be activated until the pharmacist has confirmed that there is a current, valid commercial policy on file. Those who do not have any form of insurance will also be able to utilize the LillyDirect self-pay vial options or access assistance through Lilly Cares® Patient Assistance Program.
What is the duration of the card’s validity?
Most savings card programmes will expire on December 31st of the current calendar year. Eli Lilly generally evaluates and renews these programmes annually. At the beginning of the January programme cycle, patients will usually have to download a new (refreshed) card, as well as provide updated information to the pharmacy about themselves.
Are there maximum monthly or annual benefit limits?
Yes. Each program contains specific “caps” on total savings. For example, the card may cover up to a maximum of $150 per month for covered prescriptions or up to $7,000 annually for those whose insurance does not cover the drug. Once these financial ceilings are reached, the patient becomes responsible for the remaining balance of the retail price.
Can the savings card be combined with government-funded insurance?
No. The federal government has certain laws and regulations that prohibit a manufacturer from offering co-pay cards to patients who participate in any government-sponsored health care programs, such as Medicare, Medicaid, TRICARE, or any other federally funded program. Patients enrolled in these programs should contact their health plan administrator for information about formularies, or they can visit the Lilly Cares® Foundation to determine whether or not they qualify.
Can the discount be used in conjunction with other secondary insurance?
The savings card is generally intended to act as a secondary payer to primary commercial insurance only. It cannot be “stacked” with other third-party discount cards (such as GoodRx) or used alongside other secondary insurance policies unless specifically permitted by the terms and conditions of the Eli Lilly program.
Resources
https://zepbound.lilly.com/savings-support
https://mounjaro.lilly.com/savings-resources
https://zepbound.lilly.com/coverage-savings
https://pricinginfo.lilly.com/zepbound
https://pricinginfo.lilly.com/mounjaro
