Medicare Part D coverage · 2.4 · RxCUI 2734638

2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound]

Per the CMS 2026 Part D formulary file, 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound] is covered by 11 Medicare Part D plans (0.2% of enrollable products), averaging Tier 3, with prior authorization required on 100% of covering formularies.

0.2%
Plan coverage
11
Plans covering
T3
Avg tier
100%
Prior auth required

Verify with CMS →

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.

What the CMS Formulary Data Shows for 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound]

Per the CMS 2026 Part D formulary file, 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound] (RxNorm concept RXCUI 2734638, generic name 2.4) appears on 2 distinct formulary files spanning 11 Medicare Part D plan offerings - 0.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 2 to Tier 4, with a cross-plan average of Tier 3.

Real-world access to 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 50% 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 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound] today.

Coverage Details

Formularies covering
2
Plans covering
11
Coverage rate
0.2%
Tier range
Tier 2 – Tier 4
Average tier
Tier 3, Preferred Brand

Restrictions

Prior authorization required
100% of formularies
Step therapy required
0% of formularies
Quantity limits
50% of formularies

Tier Distribution Across Plans

1 plans
Tier 2, Generic
10 plans
Tier 4, Non-Preferred

Medicare Advantage Plans (MA-PD) Covering 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound]

11 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
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

Frequently Asked Questions

Is 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound] covered by Medicare Part D?

Yes, 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound] is covered by 11 Medicare Part D plans (0.2% of all Part D formularies).

What tier is 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound] on Medicare Part D plans?

2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound] averages Tier 3 across Part D plans, ranging from Tier 2 to Tier 4.

Does 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound] require prior authorization?

100% of Part D formularies require prior authorization for 2.4 ML tirzepatide 25 MG/ML Pen Injector [Zepbound]. Step therapy: 0%. Quantity limits: 50%.

Read our methodology - how this data is sourced, computed, and verified.

Nationwide similar Part D drugs

Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.

Closest average formulary tier

Similar prior-authorization rate

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare