Zepbound® (tirzepatide) — 12.5 mg

• Zepbound KwikPen ONLY — single-dose vials and single-dose pens are NOT covered
• Pen needles are not covered — buy them separately
• Runs OUTSIDE the Part D plan (central processor: Humana, BIN 028918 / PCN MEDDGLP1BR). Not available if your Part D plan already covers a GLP-1 for you, or if you have T2D, moderate-to-severe OSA, or noncirrhotic MASH (those route through standard Part D). Filling any GLP-1 through your Part D plan after you are approved ends your Bridge eligibility for good — the next Bridge refill is rejected at the counter — and so does moving to a Part D plan type the Bridge does not cover. A prescriber must attest on the prior authorization that you met a BMI category: BMI >= 35; or >= 30 with heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or above; or >= 27 with pre-diabetes, prior myocardial infarction, prior stroke, or symptomatic peripheral artery disease. That BMI is the one you had when you STARTED GLP-1 therapy, not the one you have now — losing weight since does not disqualify you. The copay does not count toward the Part D deductible or your out-of-pocket maximum, and no coupons apply. There is no low-income subsidy — LIS beneficiaries pay it in full.

Verified Sep 4, 2026 · cms.gov