Anyone on Medicare been prescribed Zepbound for sleep apnea

@tls85 in 2026 the cap on out of pocket expenses ( for Medicare part d) is $2100. For me I will make it long before 2026 is ended

@merrychristmas Zepbound has been wonderful. 11 wks and down 33 lbs. Hardly any side effects.

@merrychristmas Thanks for replying, did you know that your out of pocket cap depends on where you live? My out of pocket cap for 2026 is $4800 🙁
This isn't doable for us, however, I did learn something yesterday while on the phone with Humana, the 2.5 and 5. ml pen costs about $520 a month, every month while the higher doses are $71 and $83 per month! It's also cheaper if you forgo the pen and inject it with a regular needle! It's as if the insurance company discourages you from beginning and if you don't know better you will give up.

@medisecy Thank you, this really helps and I'm very happy for you!

Thank you! I went to their website and chose Zepbound Pre-filled Single-dose Pen (4), 2.5 mg/0.5 mL and that I have insurance and it only said that it would be as low as $25 per month with a savings card and you can't get the savings card if you have Medicare like I do 🙁

Do you have traditional insurance? Is this how you did it or should I do it differently?

@maryro check the price for the higher doses and also for using a syringe, the price for 7.5 for me was $71/month and 10 was $83. The bottle and syringe is about half of that.

@tls85 check pricing for using a bottle of Zepbound and syringe and also the higher doses, 7.5 mg is $71 for me and $10 mg is $83, price varies by location for Medicare.

@tls85 I do think it is worth it especially if you need to lose weight. My weight loss is going slower than some, but I have been losing weight. They say that it takes a while for the sleep apnea to improve. Zepbound also helps with inflammation. I have been on prednisone for over 2 years for PMR - polymyalga rhemutica and the Zepbound has been helping me taper off the prednisone. It has helped be move better and feel better.

@tls85 I have Medicare but I went to the Lilly website and purchased the first month of 2.5mg viles (4) out of pocket while my doctor fought with them to get it covered. After several denials they finally approved the prescription but my co-payment is pretty high. I think the first month with my insurance I still had to pay over $400.00. Now on my fourth month it is down to $350.00 per month with my insurance. I did opt for the Medicare plan that allows me to pay the first $2,000 out of pocket for my prescriptions and then the rest will be covered at 100% so I am well on my way to having the rest covered at no charge. I hope this helps. I do have sleep Apnea so that is the reason Medicare approved it for me. I have been on it for 13 weeks and have lost 25 pounds and am no longer considered obese.

@tls85 it is my understanding that Medicare part D has nation wide out of pocket cap of $2100 for 2026 . The premiums / copay / deductible of part d insurance company depends on the plan and depends on where you live . Is that not right?