Tirzepatide for Prediabetes: Evidence, Eligibility, Coverage
Tirzepatide is not FDA approved for prediabetes. It is approved for type 2 diabetes and heart risk. Some doctors prescribe it when one of those uses also applies. In SURMOUNT-1, people on Zepbound lost 20.9% of body weight on average, vs 3.1% on placebo.
- Brands
- Mounjaro and Zepbound
- Best result (SURMOUNT-1)
- 20.9% weight loss
Zepbound overview
The half-life is 5 to 6 days: after 5.5 d, half is gone, and about 3% remains after five half-lives, or 27.5 d in all.
In SURMOUNT-1, results after 72 weeks showed 20.9% of body weight, compared with 3.1% on placebo.
Monthly prices are shown in US dollars, covering the list price and self-pay offers taken from the maker's price page.
Sources: FDA label (DailyMed), Eli Lilly 1 2, cnbc.com.
Who qualifies?
| Who sets the rule | Who qualifies |
|---|---|
 Mounjaro | It lowers blood sugar in adults and children 10 and older with type 2 diabetes when used with diet and exercise. |
| Mounjaro | For adults with type 2 diabetes who are at high risk, it lowers the risk of stroke and heart attack. It also lowers the risk of death related to the heart. |
 Zepbound | When used along with diet and activity, it helps adults with obesity, or overweight adults with a weight-related condition, lose weight and keep it off long term. |
| Zepbound | It treats moderate to severe obstructive sleep apnea in adults with obesity. |
| Medicare GLP-1 Bridge | BMI 35 or higher, no condition needed |
| Medicare GLP-1 Bridge | A BMI of 30 or higher, along with heart failure, blood pressure that is uncontrolled, or CKD 3a+ |
| Medicare GLP-1 Bridge | Prediabetes, a past heart attack or stroke, or PAD, plus a BMI 27 or higher |
| Typical commercial plan (Aetna policy) | BMI 30 or higher |
| Typical commercial plan (Aetna policy) | BMI 27 or higher with a weight-related condition |
| Typical commercial plan (Aetna policy) | for 6 months, a program for diet and activity must come first under |
Sources are medicare.gov 1 2, the FDA label (DailyMed) 1 2, and aetna.com.
Trial results for prediabetes
The studies included adults with obesity without diabetes, plus adults who were overweight without diabetes. They also included adults with obesity who did not have type 2 diabetes.
| Trial | Medicine | Who took part | Length | People | Main result | Comparison |
|---|---|---|---|---|---|---|
| SURMOUNT-1 | Zepbound | Adults with obesity or overweight, without diabetes | 72 weeks | 2,539 | 20.9% weight loss | 3.1% on placebo |
| SURMOUNT-5 | Zepbound | Adults with obesity, without type 2 diabetes | 72 weeks | 751 | 20.2% weight loss | Not listed |
Trial sources: SURMOUNT-5 (PubMed) and SURMOUNT-1 (FDA label (DailyMed)).
What is different for people with prediabetes?
| What changes | What the label says | Labels |
|---|---|---|
| Low blood sugar with insulin secretagogues or insulin | When used with insulin or a sulfonylurea, it is more likely to cause low blood sugar, so those doses may need to be lowered. | All of them |
| Taken with insulin or sulfonylureas | Your risk of low blood sugar goes up when you take this medicine with insulin or a sulfonylurea, such as glipizide or glimepiride. | All of them |
From the FDA labels: FDA label on DailyMed.
The label warnings come from the FDA label (DailyMed) on DailyMed.
Coverage for prediabetes
A GLP-1 used only for weight loss gets no payment from Medicare Part D.
The Medicare GLP-1 Bridge lists Zepbound at $50 per month for people who meet its rules.
Medicaid usually requires prior authorization when it covers weight-loss GLP-1s.
Sources: humana.com, CMS, KFF.
- Tirzepatide Coupon and Savings Card
- Tirzepatide Cost With Insurance
- Tirzepatide Cost Without Insurance
- Tirzepatide Insurance Coverage
- Does Medicare Cover Tirzepatide? Criteria, Copay, How to Appeal
- Does Kaiser Permanente Cover Tirzepatide? Criteria, Copay, How
- Does Medicaid Cover Tirzepatide? Criteria, Copay, How to Appeal
- Does Blue Cross Blue Shield Cover Tirzepatide? Criteria, Copay
- Does Cigna Cover Tirzepatide? Criteria, Copay, How to Appeal
Alternatives for prediabetes
| Medicine | For prediabetes | How it is taken | Trial result |
|---|---|---|---|
| Mounjaro | Not a listed use | weekly injection | Not listed |
| Zepbound | Not a listed use | weekly injection | 20.9% weight loss |
 Ozempic | Not a listed use | weekly injection | Not listed |
 Wegovy | Not a listed use | weekly injection or daily tablet | 14.9% weight loss |
 Rybelsus | Not a listed use | daily tablet | Not listed |
 Foundayo | Not a listed use | daily tablet | 11.1% weight loss |
 Trulicity | Not a listed use | weekly injection | Not listed |
 Saxenda | Not a listed use | daily injection | 7.4% weight loss |
 Victoza | Not a listed use | daily injection | Not listed |
| Byetta | Not a listed use | twice-daily injection | Not listed |
Sources: FDA label (DailyMed).
Questions for your prescriber
- For coverage, does my prediabetes count as a weight-related condition?
- Is a diabetes brand a worse fit for me than a weight-loss brand?