0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound]
tirzepatide
RxCUI: 2669718
What the CMS Formulary Data Shows for 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound]
Per the CMS 2026 Part D formulary file, 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound] (RxNorm concept RXCUI 2669718, generic name tirzepatide) appears on 13 distinct formulary files spanning 26 Medicare Part D plan offerings - 0.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.1.
Real-world access to 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 92.3% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound] today.
Coverage Details
- Formularies covering
- 13
- Plans covering
- 26
- Coverage rate
- 0.5%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 92.3% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound]
26 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | Yes | $0 | CA |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T2 | Yes | $0 | CA |
| Health First Rewards H1099-014 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Premier Access H1099-025 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $0 | FL |
| Health First Value H1099-006 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $15.00 | FL |
| Health First Classic H1099-001 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | Yes | $49.40 | FL |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T5 | Yes | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T5 | Yes | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T5 | Yes | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T5 | Yes | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T5 | Yes | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS LOUISIANA, INC. | T5 | Yes | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS NORTH CAROLINA, INC. | T5 | Yes | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH MICHIGAN, INC. | T5 | Yes | $0 | MI |
Frequently Asked Questions
Is 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound] covered by Medicare Part D?
Yes, 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound] is covered by 26 Medicare Part D plans (0.5% of all Part D formularies).
What tier is 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound] on Medicare Part D plans?
0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound] require prior authorization?
100% of Part D formularies require prior authorization for 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Zepbound]. Step therapy: 0%. Quantity limits: 92.3%.
Read our methodology - how this data is sourced, computed, and verified.