Does Anthem Cover Zepbound for Weight Loss?

It depends on your specific plan. Some Anthem plans do cover Zepbound for weight loss, but many do not. Coverage varies widely based on your plan type, your state, your employer, and whether plan includes weight management medications in its formulary. There isno blanket yes or no answer that applies to all Anthem members, so checking your individual plan.

Why Does Coverage Vary So Much?

Anthem is one of the largest insurance providers in country, but it operates across many different plan structures. Employer sponsored plans, individual marketplace plans, Medicaid managed care plans, and Medicare plans all have different formularies and coverage rules. Your employer has a significant say in what medications your plan covers, especially for self-funded plans.

Some Anthem plans explicitly exclude weight loss medications from coverage entirely. Others include Zepbound on their formulary but require prior authorization and proof of medical necessity before they approve it. And some plans that covered GLP-1 medications for weight loss in previous years have started pulling back that coverage due to high cost of these drugs.

For example, several Blue Cross Blue Shield plans tied to Anthem rolled back GLP-1 weight loss coverage heading into 2025 and 2026. California's Medi-Cal program, which includes Anthem managed care, ended coverage of Zepbound, Wegovy, and Saxenda for weight loss as of January 1, 2026. These changes do not affect every Anthem member, but they show how quickly coverage can shift.

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How Do You Find Out If Your Plan Covers It?

The most reliable way is to check your plan's drug formulary. You can do this by logging into your Anthem member portal or calling Pharmacy Member Services number printed on your insurance card. Ask specifically whether Zepbound (tirzepatide) is covered for indication of chronic weight management, and whether prior authorization or step therapy required.

You can also use the coverage checker tool on Zepbound's official website. You will need your prescription insurance card handy. The tool gives a quick estimate of whether your plan includes Zepbound, though it’s not a guarantee of coverage. Always confirm directly with Anthem for most accurate answer.

Your doctor's office can also help. They can contact Anthem on your behalf to verify coverage and start prior authorization process if needed.

What Is Prior Authorization and Why Does It Matter?

Most Anthem plans that do cover Zepbound require prior authorization before they approve the prescription. This means your doctor needs to submit paperwork showing that the medication is medically necessary for you. Typical requirements include a documented BMI of 30 or higher (or 27 or higher with a related condition like type 2 diabetes, high blood pressure, or sleep apnea), and sometimes evidence that you have already tried and not succeeded with other weight management approaches.

Some plans also use step therapy, which means you may need to try and fail with less expensive weight loss medications before Anthem will approve Zepbound. This process can add weeks to timeline, so it helps to start early and work closely with your doctor on the documentation.

Initial prior authorization approval is typically granted for about six months. At renewal, you may need to show that you have achieved at least 5% weight loss or are making continued progress to get reauthorized.

What If Your Anthem Plan Does Not Cover It?

If your plan excludes Zepbound for weight loss, you still have options.

Eli Lilly offers a savings card program for people with commercial insurance. If your plan covers Zepbound, savings card can bring your copay down to as low as $25 per month. If your commercial plan does not cover it, the card can still provide up to $620 in monthly savings, bringing cost to roughly $499 per month for single-dose pen.

For people who prefer to pay out of pocket, Lilly's LillyDirect self pay program offers Zepbound single-dose vials starting at $299 per month for the 2.5 mg dose. Higher doses range from $399 to $449 per month. No insurance is needed or accepted for this option. These prices are significantly lower than list price of about $1,086 per month.

People with government insurance like Medicare, Medicaid, TRICARE, or VA benefits are not eligible for manufacturer savings card. However, Medicaid coverage varies by state, and Medicare coverage for obesity medications may expand later in 2026.

You also hav right to appeal a coverage denial. Your doctor can submit additional documentation to Anthem explaining why Zepbound is medically necessary for your situation. If internal appeal is denied, you can request an external review through your state's insurance department.

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Could the Sleep Apnea Approval Help?

Possibly. Zepbound received a separate FDA approval for moderate-to-severe obstructive sleep apnea in adults with obesity. Some Anthem plans that exclude weight loss drugs may still cover Zepbound under this indication. If you have a documented sleep apnea diagnosis with a qualifying sleep study, your doctor may be able to pursue coverage through that route instead.

What Should You Do Next?

Start by checking your formulary and calling Anthem directly. If coverage available, work with your doctor to submit prior authorization paperwork as early as possible. If coverage is denied or excluded, explore savings card, LillyDirect pricing, and your appeal options. The landscape around GLP-1 coverage is changing quickly, so it’s worth rechecking your plan at each renewal.