Does Medicare cover Zepbound in Florida?

What Zepbound is used for

Zepbound is tirzepatide, a once-weekly injection that acts on two gut hormones (GLP-1 and GIP). Its FDA label covers chronic weight management in adults with obesity, or with overweight and a weight-related health problem, together with diet and exercise; and, since December 20, 2024, moderate to severe obstructive sleep apnea in adults with obesity. Mounjaro is the same medicine, approved for type 2 diabetes.

This page explains Medicare coverage only. Questions about whether Zepbound is right for you belong with your prescriber.

Which part of Medicare covers Zepbound

Zepbound is self-injected, so any Medicare coverage runs through Part D, in one of two ways:

• Your Part D plan can cover Zepbound for a medically accepted use that isn't weight loss alone, such as obstructive sleep apnea, if Zepbound is on its formulary. Expect prior authorization.
• The Medicare GLP-1 Bridge covers the Zepbound KwikPen for weight management when you meet CMS's criteria, outside your plan's formulary.

Federal law (Social Security Act §1860D-2(e)) excludes drugs used for weight loss from Part D, which is why a plan can't cover Zepbound for weight loss on its own. More in Does Medicare cover weight-loss drugs in Florida?

How the Medicare GLP-1 Bridge works for Zepbound

• Dates: coverage started July 1, 2026, and runs through December 31, 2027. CMS hasn't announced coverage after that.
• Which Zepbound: only the Zepbound KwikPen. Medicare.gov says the Bridge doesn't cover single-dose Zepbound vials or pens. It also covers Wegovy (injection or tablet) and Foundayo.
• Who qualifies: people with Medicare drug coverage, 18 or older, with a BMI of 35 or more; or 30 or more with diastolic heart failure, uncontrolled high blood pressure or stage 3a or later kidney disease; or 27 or more with prediabetes, a past heart attack or stroke, or peripheral artery disease with symptoms.
• Which drug coverage counts: a standalone Part D plan, a Medicare Advantage plan with drug coverage, a Special Needs Plan, an employer or union group Medicare plan, or the LI NET program.
• Who doesn't qualify: people who already get a GLP-1 through their Part D plan, and people with type 2 diabetes, moderate to severe sleep apnea or fatty liver disease. For those conditions, your Part D plan might cover a GLP-1 instead.
• How: your prescriber sends the prescription and, when asked, completes a prior authorization, certifying you're in a lifestyle program focused on diet and exercise. Medicare.gov says the approval lasts through December 31, 2027, including refills and dose changes, unless you change GLP-1s. You pay a flat copay for each one-month supply, set by CMS and shown on Medicare.gov.
• Limits: the Bridge copay doesn't count toward your Part D deductible or the $2,400 cap, and Extra Help and the Medicare Prescription Payment Plan can't be used for it.

Check eligibility at Medicare.gov/glp1bridge or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).

Is Zepbound on Medicare's negotiated-price list?

No. Zepbound is not among the drugs CMS has selected for the Medicare Drug Price Negotiation Program so far: the 10 drugs with negotiated prices since January 1, 2026, the 15 with negotiated prices starting January 1, 2027, and the 15 CMS selected on January 27, 2026, for prices that take effect in 2028.

What you pay for Zepbound in 2027: the out-of-pocket cap

Your cost for Zepbound depends on your plan: its deductible, the tier it puts the drug on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:

• 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
• The maximum Part D deductible for 2027 is $700. No plan can set a higher deductible.
• Only covered drugs count. If your plan doesn't cover Zepbound and you pay cash, or you use a discount card instead of your plan, that spending doesn't count toward the cap.

These cost rules apply when your Part D plan covers Zepbound, for example for sleep apnea. Zepbound through the GLP-1 Bridge has its own copay, which doesn't count toward the cap.

Spreading the cost: the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan lets you pay your Part D drug costs in monthly bills from your plan across the calendar year instead of all at once at the pharmacy. Medicare.gov says there's no cost to participate, but it doesn't lower your drug costs; it only changes when you pay. It helps most when your costs are high early in the year. It applies to drugs your Part D plan covers, not to the GLP-1 Bridge copay. To join, call your plan or use its website. More in What is the Medicare Prescription Payment Plan?

Extra Help with Zepbound

Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have full Florida Medicaid, SSI or a Medicare Savings Program (QMB, SLMB or QI-1, which you apply for through ACCESS Florida, run by the Department of Children and Families). Otherwise, apply through Social Security at ssa.gov/extrahelp or 1-800-772-1213 (TTY 1-800-325-0778). Florida has no state drug-assistance program for seniors, so Extra Help is the main public help with Part D costs. See Extra Help in Florida and does Florida have a state drug program for seniors?

Getting Zepbound covered in Florida

Florida is its own Part D region (PDP Region 11), so each standalone Part D plan sold here is offered in all 67 counties. For 2027, CMS lists 11 standalone Part D plans from 6 companies in Florida. Every county also has Medicare Advantage plans open to everyone, from 7 in Monroe County to 52 in Hillsborough County. Each plan has its own formulary, so one plan's coverage of Zepbound tells you nothing about another's. Your county's numbers are on Florida counties.

Military retirees: since August 31, 2025, the TRICARE pharmacy benefit doesn't cover weight-loss drugs for TRICARE For Life beneficiaries when obesity is the primary diagnosis. TRICARE's own page points TRICARE For Life beneficiaries to the Medicare GLP-1 Bridge, which requires Medicare drug coverage (Part D). If you rely on TRICARE pharmacy coverage alone, you'd need to join a Part D plan at an allowed time, such as Open Enrollment, to use the Bridge. See military, veterans and TRICARE in Florida.

Hurricane season: Zepbound has to be kept cold. The label says an unopened KwikPen can be kept at room temperature (up to 86°F) for no more than 30 days and must be protected from heat, so a long power outage after a storm can ruin your supply; keep your pharmacy's and plan's phone numbers with your emergency supplies. Medicare.gov says that if you live in a declared disaster area, your drug plan can help you find another in-network pharmacy, replace drugs that were lost, damaged or left behind when you evacuated, and fill prescriptions at an out-of-network pharmacy when you can't reasonably reach a network one (keep your receipts). CMS guidance also expects Medicare drug plans to lift "refill-too-soon" limits after a federal disaster declaration. Florida's emergency-refill law (s. 252.358) makes insurers and HMOs licensed by the Office of Insurance Regulation allow early refills when your county is under a hurricane warning or a state of emergency, but it doesn't mention Medicare, so ask your Medicare plan directly. See early refills before a hurricane.

Plans ending in 2027: at least 302,773 Floridians in regular Medicare Advantage plans that are leaving or ending must choose new coverage for 2027. If yours is one, your plan sends a non-renewal letter and you have a special enrollment period through February 28, 2027; to keep Zepbound covered without a gap, choose new drug coverage by December 31, 2026. See plans ending in 2027.

Snowbirds: a Florida Part D plan's service area is Florida, and you can belong to only one Part D plan, tied to your permanent home. If you spend part of the year in another state, ask the plan whether its pharmacy network includes pharmacies where you'll be, or whether it offers mail order, before you leave with your Zepbound. A Part D plan disenrolls you only after more than 12 months away. See snowbird prescriptions.

How to check whether a plan covers Zepbound

1. Write down the exact drug. Name, strength and how often you take it. A plan can cover one form of Zepbound and not another, and the GLP-1 Bridge covers only the KwikPen.
2. Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Zepbound and any rules.
3. Read the rules next to the drug. Prior authorization, step therapy or quantity limits mean your prescriber may need to send the plan information before it pays.
4. Check your 2027 notice. Your plan's Annual Notice of Change says whether Zepbound stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
5. Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.

If your plan doesn't cover Zepbound, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if your prescriber says waiting could seriously harm your health. New members can usually get a one-time transition supply of a drug they were already taking while they ask for an exception or switch. See How do I appeal a Medicare denial in Florida?

Sources

• National Library of Medicine — DailyMed: Zepbound prescribing information (FDA label, including storage)
• FDA — FDA approves first medication for obstructive sleep apnea (Zepbound, December 20, 2024)
• Medicare.gov — Medicare GLP-1 Bridge
• CMS — Medicare GLP-1 Bridge (July 1, 2026 – December 31, 2027)
• Social Security Act §1860D-2(e) (drugs excluded from Part D, including drugs for weight loss)
• TRICARE — TRICARE For Life (weight-loss drug coverage update)
• Medicare.gov — Drug coverage (Part D)
• CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program; data file of November 2, 2026)
• CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold, deductible and Extra Help copays)
• Medicare.gov — Medicare Prescription Payment Plan
• Social Security — Extra Help with Medicare prescription drug plan costs
• eCFR — 42 CFR 423.120 (formularies and transition fills)
• CMS — Medicare Advantage and Part D Landscape files, 2027 (PDP Region 11: Florida)
• Medicare.gov — Getting drugs in a disaster or emergency
• CMS — Pharmacy access during a federal disaster declaration: Q&As for Part D plan sponsors (2017)
• Florida Statutes — s. 252.358, emergency prescription refills

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