Zepbound for Prediabetes: Evidence, Eligibility, Coverage
Zepbound is not FDA approved for prediabetes. It is approved for weight loss and sleep apnea. 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.
- Active ingredient
- tirzepatide
- How it is taken
- weekly injection
- Approved for
- Weight loss and sleep apnea
- Best result (SURMOUNT-1)
- 20.9% weight loss
Zepbound overview
The half-life is 5 to 6 days. By 5.5 d, half has gone, and about 3% is still there after five half-lives (27.5 d).
In SURMOUNT-1 over 72 weeks, people lost 20.9% of body weight, compared with 3.1% on placebo.
Monthly prices in US dollars include the list price and self-pay offers. Each price comes from the maker's price page.
Sources: FDA label (DailyMed), Eli Lilly 1 2, cnbc.com.
Who qualifies?
| Who sets the rule | Who qualifies |
|---|---|
| FDA label | Used along with diet and activity, it helps adults who have obesity, or who are overweight and also have a weight-related condition, lose weight and keep that loss long term. |
| FDA label | For adults who have obesity, it treats sleep apnea that is moderate to severe and obstructive. |
| Medicare GLP-1 Bridge | BMI 35 or higher, no condition needed |
| Medicare GLP-1 Bridge | The rules call for a BMI of 30 or above, plus heart failure, uncontrolled blood pressure, or CKD 3a+ |
| Medicare GLP-1 Bridge | You meet the rule with Prediabetes, PAD, or a heart attack or stroke you had before, plus 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) | first comes a diet and activity program lasting 6 months |
For references, see medicare.gov 1 2, aetna.com, and the FDA label (DailyMed).
Trial results for prediabetes
In none of these trials was enrollment limited to prediabetes. Those studied were adults with obesity or overweight and no diabetes, plus adults who had obesity but not 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 |
The evidence is based on SURMOUNT-1 (FDA label (DailyMed)) and SURMOUNT-5 (PubMed).
What is different for prediabetes?
| What changes | What the label says |
|---|---|
| Hypoglycemia | Taking this with insulin or a sulfonylurea raises the chance of low blood sugar. Doses of those drugs may need lowering. |
| Taken with insulin or sulfonylureas | Taking it with insulin or a sulfonylurea, such as glipizide or glimepiride, raises the risk of low blood sugar. |
This information is provided in the FDA labels: FDA label (DailyMed).
The label warnings appear in the FDA label on DailyMed.
Coverage for prediabetes
Medicare Part D pays nothing for a GLP-1 when its only use is weight loss.
If you qualify under the Medicare GLP-1 Bridge rules, the listed Zepbound price is $50 per month.
Where Medicaid covers weight-loss GLP-1s, prior authorization is usually required.
Sources: humana.com, CMS, KFF.
Alternatives for prediabetes
| Medicine | For prediabetes | How it is taken | Trial result |
|---|---|---|---|
| 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 |
 Mounjaro | Not a listed use | weekly injection | 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 to ask your prescriber
- Does my plan count my prediabetes as a condition related to weight?
- Is a weight-loss brand a better fit for me than a diabetes brand?
Read the full Zepbound prescribing information on DailyMed.