Does Kaiser Permanente cover Zepbound?
From published formulary and policy documents for the plan type below. Not a decision for your member ID.
Sources last checked October 24, 2026
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Coverage varies. Kaiser Northwest treats Zepbound as non-formulary and requires a clinical review. Initiation needs a 3-month adequate trial of at least two alternatives (phentermine, diethylpropion, topiramate, Qsymia, Contrave) and a 6-month semaglutide trial before tirzepatide, with indications of chronic weight management (BMI 30+, or 27+ with comorbidity) or OSA without diabetes. Continuation needs 5% or greater weight loss at annual review.
Applies to: Kaiser Permanente Northwest region (CPS/AWC), commercial; weight-loss coverage only for members whose plan includes it. Other regions differ
Source: Kaiser Permanente Northwest: Criteria for Drug Coverage, tirzepatide (Zepbound), Revised 2025-06-12; effective 2025-08-07
Policy details
Sources last checked October 18, 2026
Approval criteria
- Adult chronic weight management: BMI of 30 or higher, or BMI of 27 or higher with at least one documented comorbidity (hypertension, diabetes or hyperlipidemia).
Source: Kaiser Permanente Northwest Region Criteria for Coverage: tirzepatide (Zepbound)
Step therapy
First, failed an adequate trial (defined as 3 months) of at least two of phentermine, diethylpropion, topiramate, phentermine/topiramate (Qsymia) or naltrexone/bupropion (Contrave), or an allergy, intolerance or contraindication to all of them. Then failure of a minimum 6-month semaglutide (Ozempic or Wegovy) trial, followed by a bariatric medicine chart review, unless there is an allergy, intolerance or contraindication to semaglutide.
Source: Kaiser Permanente Northwest Region Criteria for Coverage: tirzepatide (Zepbound)
Approval length
12 months
Source: Kaiser Permanente Northwest Region Criteria for Coverage: tirzepatide (Zepbound)
Renewal criteria
- Updated weight and BMI are recently documented.
- Achieved and maintained 5% or greater weight loss after starting tirzepatide (Zepbound).
- Reviewed every 12 months.
Source: Kaiser Permanente Northwest Region Criteria for Coverage: tirzepatide (Zepbound)
Exclusions and limits
- Covered for weight loss only for Kaiser Northwest members whose plan includes coverage for weight-loss medications. Others pay the member cash price.
Source: Kaiser Permanente Northwest Region Criteria for Coverage: tirzepatide (Zepbound)
Policy
Revised 06/12/25, effective 08/07/25
Source: Kaiser Permanente Northwest Region Criteria for Coverage: tirzepatide (Zepbound)
Effective August 7, 2025
Source: Kaiser Permanente Northwest Region Criteria for Coverage: tirzepatide (Zepbound)
Region and plan differences
These criteria are for the Kaiser Permanente Northwest region (Kaiser Foundation Health Plan of the Northwest). Kaiser publishes criteria by region, and the document tells members to contact Pharmacy Services in their home region, so coverage in other regions can differ.
Source: Kaiser Permanente Northwest Region Criteria for Coverage: tirzepatide (Zepbound)
What this means
The published policy lists approval criteria, step therapy, an initial approval of 12 months, continuation criteria, and uses that are not covered.
This reflects the insurer's published formulary and policy for the plan type above. Your employer or plan may exclude weight-loss drugs or differ. Confirm with the number on your ID card.