How to Get Tirzepatide: Prescription Paths, Coverage, and Safe Access (2025 Guide)

How to Get Tirzepatide

Follow three steps:

1. Complete an evaluation with a licensed clinician to determine whether tirzepatide is appropriate based on your health history and goals. 
2. A prescription is then sent to a network pharmacy if clinically appropriate. 
3. If eligible, fill a prescription at a retail or specialty pharmacy.

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Who May Qualify

There are two distinct FDA-approved brand versions of medications containing tirzepatide. Understanding their differences and specific approved purposes will help determine qualification.

Qualification criteria for each:

1. Zepbound®: You may qualify if you have a BMI of 30 kg/m² or higher, or a BMI of 27 kg/m² or higher and at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high cholesterol. Zepbound® is also approved for moderate to severe obstructive sleep apnea in adults with obesity.
2. Mounjaro®: Is approved to treat adults with type 2 diabetes alongside diet and exercise.

Medications containing tirzepatide may not be appropriate for individuals who are pregnant, have a personal or family history of specific thyroid cancers, including medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. 

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Paths to a Prescription

In-Person Care (PCP/Endocrinology)

Schedule an appointment with your primary care physician (PCP), endocrinologist, or specialist in obesity medicine to determine your eligibility. This path allows for on-site blood work and additional screenings, if necessary. However, this option may take longer from start to finish with wait and travel times, or delays in manual prescription processing.

Telehealth Evaluation

Telehealth services connect you with licensed healthcare providers online without the need for travel or waiting rooms. This option works well if you have mobility issues, limited access to healthcare facilities, or a busy schedule.

You’ll complete an intake form, verify your identity, and meet with a licensed provider by video or secure chat. If clinically appropriate, the provider will issue a prescription and send it to a pharmacy that is part of your plan and located near you.

Timelines vary by patient and plan. If eligible, you’ll receive your prescription electronically, which can then be filled at your preferred pharmacy.

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Getting FDA-Approved Tirzepatide 

Where You’ll Fill

Clinicians typically send prescriptions to retail or specialty pharmacies. Your plan may require you to use preferred in-network pharmacies.  

Prior Authorization Basics

Many insurance plans may require prior authorization, with documentation of your BMI and any weight-related health conditions, before they’ll cover medications containing tirzepatide. Your doctor may need to submit paperwork to demonstrate the medical necessity of the medication.

Paying With Insurance vs. Cash

Your out-of-pocket cost depends on your insurance coverage (e.g., deductible, copay/coinsurance, and type of medication dispensed). Check with your plan for any manufacturer savings or pharmacy programs you may qualify for.

Self-pay options provide an alternative when insurance doesn’t cover the medication. For current cash-pay options and any manufacturer savings programs (e.g., LillyDirect® and savings cards), review the manufacturer’s website and eligibility terms; pricing and eligibility can change.

Compare all options carefully, as the most cost-effective approach depends on your specific insurance benefits and medication needs.

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About Compounded Tirzepatide (If Clinically Appropriate)

When a Prescriber Might Consider It

FDA-approved medications containing tirzepatide remain the standard treatment options for most patients. A prescriber may order a compounded formulation only when they determine a clinically significant difference for a specific patient (e.g., a formulation or component differences that meet that patient’s needs).

How It Differs From FDA-Approved Drugs

Compounded medications are not FDA-approved. Formulation and potency may vary. Do not treat compounded products as “generic,” “equivalent,” or “the same as” branded drugs.

Compounded medications are not reviewed or approved by the FDA for safety, efficacy, or quality.

Safe Access Checklist

• Obtain a valid prescription (when clinically appropriate) from a licensed clinician
• Use a licensed 503A pharmacy that fits patient-specific prescriptions.
• Confirm clear labeling and access to pharmacist counseling.
• Avoid “no prescription needed,” dramatic discounts, imports, or guaranteed results.

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Coverage & Cost Playbook

How to Check Your Coverage (Fast)

1. Log in to your insurance plan portal or call the member services number on your card. Zepbound® and Mounjaro® have online evaluation tools to assess coverage as well. 
2. Search the plan’s formulary for tirzepatide products and note any prior authorization or step-therapy requirements. 
3. Ask which network pharmacies the plan prefers and whether specialty routing applies.

If Denied

Insurance companies may deny coverage for several reasons:

1. The medication requires prior authorization
2. Weight loss medications aren’t covered
3. You don’t meet the BMI requirements
4. Your plan doesn’t cover weight-related care

Review the denial reason and then work with your clinician to submit an appeal or consider possible alternatives covered under your plan. Make sure to keep documentation of submissions, including timelines.

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Starting Treatment: What to Expect Next

Once prescribed, your pharmacy will arrange for pickup or delivery and review instructions for use for your prescription. Schedule follow-up appointments with your physician to discuss dosing decisions and monitor your progress. Do not change the dose on your own. For injection site tips, check out Where to Inject Tirzepatide. 

Lean on your care team, fill at a licensed pharmacy, and follow the product’s instructions for use. Together with your clinician, you can begin confidently and safely.

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