Zepbound® (tirzepatide) single dose vials became available in August 2024 in 2.5 mg and 5 mg dose. It is a medication that is FDA-approved for weight loss in individuals who meet certain criteria,* and originally was available only in an autoinjector pens. The vials are available for self-pay at a discount, making them more accessible to individuals without insurance or those ineligible for savings programs. Zepbound works by activating the receptors of two hormones: glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), helping to reduce appetite and food intake, and supporting long-term weight management. Clinical studies show that patients using the 5 mg dose, along with a reduced-calorie diet and increased physical activity, achieved an average of 15% weight loss over 72 weeks. At this time, the 5 mg vial is the highest dose that is sold in the United States and the autoinjector is available in doses up to 15 mg.

*BMI 30+ or 27+ with weight related medical conditions such as high blood pressure, high cholesterol, etc.

Zepbound vials are different from Zepbound injection pens (aka autoinjectors) in several ways.  Zepbound vials contain the same medication that’s used in the injector pens, a dual GLP-1/GIP receptor agonist called tirzepatide. The key differences are listed below.

• Zepbound vials each contain a single dose of medication that are administered with a separate syringe and needle. The Zepbound injection pens are pre-filled, single use pens with the needle self-contained inside.  
• Zepbound vials require additional supplies including a syringe, needle, and an alcohol wipe to sterilize the injection site and the rubber top of the vial. Step by step instructions for administering the medication can be found on the Eli Lilly website.
• The available doses of Zepbound in the vial form are only 2.5 mg and 5 mg while the injection pen is available in all doses ranging from 2.5 mg up to 15 mg.
• The vials are available as “cash pay” through the Lilly Direct pharmacy  and do not go through insurance whereas the injector pens may be covered by insurance. Some individuals who cannot access Zepbound injector pens due to high cost and lack of insurance coverage may be able to afford the vials which are priced at a lower cost. Both the vials and injector pens require a prescription from a healthcare clinician.

Zepbound is intended for long-term use for both weight loss and chronic weight management.  Therefore, if you are planning on paying for this medication out of pocket it is important to take into consideration if you are able to continue to bear this cost long-term.  Studies have shown that if Zepbound is stopped patients typically regain much of the weight that has been lost, and this has also been shown with other injectable weight loss medications.

At the time of writing, a four week supply of Zepbound weight loss medication (tirzepatide)  2.5 mg single-dose vials is priced at $399 and a four-week supply of the 5 mg dose costs $549. This pricing is more than 50% less than the list price of other injectable weight loss medications used to treat obesity such as Saxenda® and Wegovy®. The single-dose vials require a valid prescription, but do not go through insurance, meaning they are “cash pay” only. This provides a transparent pricing option outside of insurance and potentially increases access to the medication.

To inject a Zepbound (tirzepatide) single-dose vial, you will need additional supplies including a syringe and needle, alcohol swab and/or isopropyl alcohol on gauze/cotton ball, and a sharps container for disposal of used needles and syringes. Below are step-by-step instructions:

• Remove the vial from the refrigerator and confirm the dosage and expiration date. The medication should be colorless to slightly yellow. Ensure that the medicine is not frozen, not cloudy and does not have particles in it.
• Start by washing your hands with soap and water and clean the injection site with alcohol. You will inject under the skin in the abdomen, thigh, or back of the upper arm. 
• Pull the plastic protective cap off the Zepbound vial and wipe the rubber stopper with the alcohol swab.
• Place the needle on the syringe (if needed) and remove the protective cap, then pull down the plunger until you’ve drawn 0.5 mL air into the syringe. This will make it easier to remove Zepbound from the vial. 
• Puncture the rubber stopper of the vial with the syringe and push the plunger all the way down to inject air into the vial.
• With the syringe still in the vial, turn the vial and syringe upside down so the liquid accumulates at the bottom. Then, making sure the tip of the needle is below the liquid, pull down on the plunger until the plunger tip is past the 0.5 mL line. If there are any air bubbles, gently tap the syringe a few times so they rise to the top. Then push the plunger up until it is at the 0.5 mL line. Remove the syringe from the vial.
• Pinch the skin at the injection site and insert the needle subcutaneously (under the skin) at a 45-degree angle. Slowly inject the medication and make sure the needle is in your skin for at least 5 seconds to make sure you get the full dose. Then remove the needle. 
• Properly dispose of the syringe and vial in a sharps container. Do not attempt to recap the needle.

You can also read the full instructions for use and watch an instructional video (under the “Vial” tab) for more information. Always follow your healthcare clinician’s instructions and consult with them on any questions.

To get a prescription for Zepbound (tirzepatide) vials, you must meet certain criteria. Zepbound is FDA-approved for weight loss for adults with a BMI 30+ or 27-29.9 a with a weight-related medical condition such as prediabetes, high cholesterol, or sleep apnea and is to be used in combination with a low calorie eating pattern and increased physical activity. Your healthcare clinician should also take into consideration other aspects of your medical history to ensure you are a good candidate for this medication.

If eligible, your healthcare clinician will send a prescription for Zepbound vials to LillyDirect Pharmacy, and from there you will be contacted regarding the next steps to check out. You can also purchase ancillary supplies like syringes and needles through LillyDirect Pharmacy or separately from your local pharmacy (note: some states require a prescription to purchase syringes and needles). The Zepbound vials are only available through LillyDirect Pharmacy and are not available at pharmacy chains at the time of writing.

No, insurance does not cover Zepbound vials. However, they are offered at a much lower price compared to autoinjector pens. At the time of writing, the cost of the Zepbound vials is $399 for a four-week supply of 2.5 mg or $549 for a 4-week supply of 5 mg. Zepbound vials are only available through the LillyDirect® pharmacy. The Zepbound autoinjectors, if not covered by insurance, may be available at a discount price of $650 for a 4 week supply for those who are eligible for the coupon savings (restrictions apply). You should discuss with your medical clinician whether Zepbound is appropriate for you, and if so, whether vials or autoinjectors would be best.

No, Zepbound vials do not count toward your insurance deductible. You would be responsible for the entire cost of the vials in addition to the supplies required to administer the medication. You may be able to apply Flexible Spending Account or Health Savings Account (HSA) funds to pay for Zepbound vials and supplies, but you will need to refer to your plan’s list of eligible expenses for confirmation. In some cases, Zepbound autoinjectors may count towards your insurance deductible, but you would need to confirm this with your insurance plan, as this medication is frequently a plan exclusion and in that case would not count towards the deductible. It is important to reach out to your insurance provider to understand your plan benefits and coverage limitations as they will have the most up to date information.

Zepbound vials are currently only available in the two lowest doses of medication: 2.5 mg and 5 mg. In general, patients start at the lowest dose of 2.5 mg. After taking the 2.5 mg dose weekly for 4 weeks, the patient will discuss with their healthcare clinician whether they increase the dose or stay at the same dose. This is dependent on a number of factors including how well you are tolerating side effects of the medication and how the medication is affecting your appetite and nutrition. The 5 mg dose is considered a maintenance dose and some patients are able to lose weight and stay on this dose long term. The Zepbound autoinjector pens, by comparison, are available in all dosages: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg.

Yes, we recommend that patients make the switch from compounded “tirzepatide” to Zepbound vials or pens as long as the patients were started on weight loss medication appropriately. Weight loss medications are intended for long-term use in individuals with a BMI of 30+ or 27+ with a weight related medical condition (e.g. high blood pressure, high cholesterol, diabetes) in combination with a low calorie eating pattern and increased physical activity.

There are significant safety concerns surrounding compounded medications. Compounded medications can vary greatly in the quality and they do not go through the same rigorous testing for safety and efficacy as FDA-approved medications. Leading obesity expert organizations- Obesity Medical Association, Obesity Action Coalition and The Obesity Soceity- issued a statement on compounded medications and the FDA issued a warning about use of compounded medications for weight loss. At Form Health, we prioritize patient safety, and we do not use compounded medications in our practice. Our medical clinicians are experienced in helping patients transition from compounded medications to FDA-approved medications, if appropriate.