Commercial coverage
Does Anthem (Elevance Health) cover Zepbound?
Zepbound (tirzepatide) for weight loss / obesity — the Anthem (Elevance Health) prior-authorization rule, source-cited.
Anthem (Elevance Health) Zepbound PA criteria
Elevance does not cover GLP-1s prescribed only for weight loss except in states that mandate it.
Where covered (verified on Anthem HealthKeepers Plus / VA Medicaid weight-loss form; commercial summaries are more lenient): Wegovy/Saxenda min age 12, Zepbound min age 18; BMI >40 with no applicable risk factors, OR BMI >37 with >=1 of dyslipidemia, hypertension, or type 2 diabetes; tried and failed (or intolerant to all) one non-GLP-1 weight-loss medication; not concurrently on another GLP-1; no contraindications (acute pancreatitis, MTC/MEN2 history); participation in nutritional counseling + physical activity program with a medical status/weight-loss plan from within the last 60 days.
Initial authorization 6 months; continuation 6 months if >=5% body-weight reduction vs most recent auth; renewals stop once member reaches BMI <25.
Commercial designs more lenient (~BMI >=30 / >=27+comorbidity, ~3-6mo lifestyle, ~5% renewal) per secondary sources, not Anthem's universal rule.
Source: Anthem HealthKeepers Plus VA Medicaid Weight Loss PA Form (VABCBS-CD-091232-25, Oct 2025) & Anthem CA diabetes Code I doc (CA-BC-CD-001363-25-S604, Nov 2025). View cited GLP-1 policy reference →
Note: tirzepatide is also sold as Mounjaro for type 2 diabetes, which Anthem (Elevance Health) evaluates under a separate type 2 diabetes policy (not this one) — see does Anthem (Elevance Health) cover Mounjaro?. Coverage follows the brand's FDA indication, not the molecule.
Frequently asked
- Does Anthem (Elevance Health) cover Zepbound for weight loss / obesity?
- Varies by plan — PA required where covered. Elevance does not cover GLP-1s prescribed only for weight loss except in states that mandate it. See the full source-cited criteria above. Per Anthem HealthKeepers Plus VA Medicaid Weight Loss PA Form (VABCBS-CD-091232-25, Oct 2025) & Anthem CA diabetes Code I doc (CA-BC-CD-001363-25-S604, Nov 2025), as of 2025 (WL form Oct 2025; CA diabetes doc Nov 14 2025; Trulicity Code I eff. 1/1/2026; WL CDL removal eff. 1/1/2026) — confirm the member's current plan policy.
d3rx does not hold plan-specific pharmacy formularies or PBM prior-auth grids, so it cannot confirm a particular plan's GLP-1 coverage, tier, or PA criteria. The guidance below is the general, source-cited rule; confirm the specific plan's pharmacy formulary / PA policy for a binding answer.
Check Zepbound for another payer — or draft the PA
Run Zepbound + any payer in the GLP-1 PA lookup, or have Ask D3 draft a Anthem (Elevance Health)-ready prior-authorization request with the right criteria and codes — free, no signup.