What Is the Medicare Price for Zepbound in 2026?

Direct Answer: The Price Depends on the Pathway

Depends on why Zepbound is prescribed and which Medicare pathway applies. Starting July 1, 2026, the CMS GLP-1 Bridge Program charges $50 a month for Zepbound prescribed for obesity. For obstructive sleep apnea, a covered Part D plan typically charges 25% to 33% coinsurance, about $140 to $350 a month, until the annual $2,100 out-of-pocket cap is reached. Without coverage, Zepbound's list price is about $1,060 a month.

The $50 Price Under the 2026 GLP-1 Bridge Program (Obesity)

CMS built the GLP-1 Bridge Program into the 2026 Medicare Advantage and Part D Final Rule specifically to set a flat, predictable price for Zepbound and Wegovy when prescribed for obesity. Effective July 1, 2026, a Part D enrollee who meets the clinical criteria pays exactly $50 a month for the Zepbound KwikPen, regardless of dose. Eligibility requires a BMI of 35 or higher, a BMI of 30 or higher with a comorbidity such as heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or higher, or a BMI of 27 or higher with prediabetes, a prior heart attack, stroke, or peripheral artery disease.

Eli Lilly and Novo Nordisk negotiated a net price of roughly $245 a month with CMS under a most-favored-nation style deal, a discount of about 75% to 80% off the retail list price. Medicare and the manufacturer split that net cost so the beneficiary's share lands at $50. One important price detail: that $50 does not count toward the 2026 Part D out-of-pocket cap of $2,100, because the Bridge Program operates as a demonstration outside the standard Part D benefit structure through December 31, 2027.

What Standard Part D Charges for the Sleep Apnea Indication

Original Medicare Part D can price Zepbound differently when the prescription targets obstructive sleep apnea rather than obesity, because OSA sits outside the statutory weight-loss exclusion in Social Security Act Section 1927(d)(2)(A). A prescriber who submits the ICD-10 diagnosis code G47.33 for OSA opens the door to standard Part D formulary pricing rather than the exclusion or the Bridge Program.

Plans that place tirzepatide on a specialty tier for the OSA indication typically set 2026 coinsurance between 25% and 33%. Applied to a $550 to $1,000 list price range for the pen doses, that coinsurance works out to roughly $140 to $350 a month before the deductible phase ends and until spending reaches the $2,100 annual out-of-pocket cap set by the Inflation Reduction Act of 2022. Beneficiaries should call their plan or check the Medicare Plan Finder before assuming their formulary includes Zepbound for OSA in 2026, because coverage is far from universal across Part D plans.

Zepbound's Full Price Without Any Medicare Coverage

Beneficiaries who do not meet the Bridge Program's clinical criteria and whose plan does not price Zepbound favorably for OSA face the full list price. Eli Lilly's 2026 wholesale acquisition cost for the Zepbound pen runs approximately $1,060 a month across the maintenance doses (5 mg through 15 mg), a price that has held roughly steady since 2024. That figure applies before any pharmacy dispensing fee.

Eli Lilly's LillyDirect self-pay vial program undercuts that list price substantially: $299 a month at the 2.5 mg dose, $399 a month at 5 mg, and $449 a month at 7.5 mg and above, as of late 2025 pricing carried into 2026. Manufacturer savings cards that lower commercial-insurance copays are generally not available to Medicare beneficiaries under the federal anti-kickback statute, but the LillyDirect self-pay vial price applies to any patient paying entirely out of pocket, Medicare beneficiaries included, provided no insurance benefit is applied to the transaction.

How Medicare Advantage Pricing Can Differ

Medicare Advantage plans bundle Part D drug coverage with medical benefits and can add supplemental drug benefits beyond what standard Part D allows. A small but growing number of the more than 3,300 Medicare Advantage plans nationwide priced Zepbound as a 2026 supplemental benefit, sometimes at $0 copay for enrollees who meet the plan's own clinical criteria, sometimes at a flat copay similar to the Bridge Program, and sometimes at standard coinsurance identical to Original Medicare's Part D pricing.

Pinning down the exact 2026 price for a specific Medicare Advantage plan requires pulling that plan's Evidence of Coverage document or calling member services, because the supplemental benefit filing is plan-specific and not standardized the way the GLP-1 Bridge Program is. During the Annual Enrollment Period, October 15 through December 7, 2026, for coverage beginning January 1, 2027, beneficiaries can compare plans by Zepbound pricing using the Medicare Plan Finder.

How Medicare's Price for Zepbound Compares to ACA Marketplace and Medigap Plans

Original Medicare itself sets no price for Zepbound: Medicare Part A prices hospital stays and Medicare Part B prices outpatient services and durable medical equipment such as CPAP machines, but neither part touches a self-injected prescription drug. Every Zepbound price described on this page flows through Medicare Part D, either standalone or bundled into a Medicare Advantage plan. Medigap policies, which supplement Original Medicare's Part A and Part B cost-sharing, play no role in Zepbound's price; a Medigap plan does not reduce a Part D copay no matter how comprehensive its other benefits are.

Some ACA-compliant marketplace plans in states that mandate anti-obesity drug coverage as part of essential health benefits price Zepbound lower than Medicare's standard list price, even before the 2026 Bridge Program narrowed that gap. Medicare, unlike marketplace enrollment history in the pre-ACA era, applies no medical underwriting and no preexisting condition exclusion, so a beneficiary's Zepbound price depends only on the prescribed indication and the chosen pathway, never on prior health history.

Alternatives If the Price Is Still Too High

Beneficiaries who cannot access the $50 Bridge Program price and whose plan prices Zepbound unfavorably for OSA have several ways to bring the price down further.

• Apply for Extra Help: qualifying beneficiaries with income at or below 150% of the federal poverty level ($23,940 for an individual in 2026) pay just $12.65 for a covered brand-name drug once their plan's formulary includes Zepbound.
• Switch to LillyDirect vials: the self-pay vial price of $299 to $449 a month often beats a plan's OSA coinsurance, especially early in the year before the deductible is met.
• Compare Medicare Advantage plans during the Annual Enrollment Period: some plans price Zepbound as a low-cost or $0 supplemental benefit, which can beat standard Part D pricing for the same indication.
• Ask about Eli Lilly's LillyAnswers patient assistance program: very low-income Medicare beneficiaries who do not qualify for Extra Help may still qualify for manufacturer assistance; call 1-800-545-5979 to confirm current 2026 terms.
• Consider Wegovy pricing under the same Bridge Program: Wegovy (semaglutide) carries the same $50 obesity-indication price under the 2026 GLP-1 Bridge Program and may fit a different clinical profile.

How much does Zepbound cost with Medicare Part D in 2026?

The price depends on the indication. For obesity, the 2026 CMS GLP-1 Bridge Program sets a flat $50 monthly price starting July 1, 2026. For obstructive sleep apnea, a Part D plan that covers tirzepatide typically charges 25% to 33% coinsurance, roughly $140 to $350 a month, until the $2,100 annual out-of-pocket cap is reached.

What exactly is the GLP-1 Bridge Program copay?

The GLP-1 Bridge Program sets a flat $50 monthly price for the Zepbound KwikPen when prescribed for obesity, starting July 1, 2026 and running through December 31, 2027. Eligibility requires a BMI of 35 or higher, or 30 or higher with a qualifying comorbidity, or 27 or higher with prediabetes or cardiovascular history.

Does the $50 Bridge Program price count toward the Part D out-of-pocket cap?

No. The 2026 Part D out-of-pocket cap of $2,100, set by the Inflation Reduction Act of 2022, applies to standard Part D cost-sharing. Because the Bridge Program funds tirzepatide outside that standard benefit structure, the $50 monthly price never counts toward the cap.

How much is Zepbound without any Medicare coverage in 2026?

Zepbound's 2026 list price runs about $1,060 a month for the auto-injector pen doses. Eli Lilly's LillyDirect self-pay vial program offers a lower price of $299 to $449 a month depending on dose, available to any patient paying entirely out of pocket, Medicare beneficiaries included.

Does Medicare Advantage change the price of Zepbound?

It can. Some Medicare Advantage plans price Zepbound as a 2026 supplemental drug benefit, sometimes at $0, sometimes at a flat copay, sometimes at standard coinsurance. Pricing is plan-specific, so check the plan's Evidence of Coverage or the Medicare Plan Finder.

Can Extra Help lower my Zepbound price?

Yes, if the plan already covers Zepbound. Full-benefit Extra Help recipients pay just $12.65 for a covered brand-name drug in 2026. Eligibility requires income at or below 150% of the federal poverty level, $23,940 for an individual in 2026.

Is Zepbound cheaper under Medicare than paying cash through LillyDirect?

It depends on the pathway. The GLP-1 Bridge Program's $50 price and Extra Help's $12.65 price both beat LillyDirect's $299 to $449 cash price. But standard Part D coinsurance for the OSA indication, roughly $140 to $350 a month, can run higher than LillyDirect vials in some cases.

What is the price difference between Zepbound for obesity versus sleep apnea under Medicare?

The obesity indication now prices lower in most cases: $50 a month under the 2026 GLP-1 Bridge Program. The sleep apnea indication runs through standard Part D formulary pricing, which typically lands between $140 and $350 a month in coinsurance, higher than the Bridge Program price but far below the $1,060 list price.