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HealthRX.com · Printable coverage checklist

Zepbound approval and coverage checklist for prescriber and insurer

Use this sheet before a prescriber or pharmacist visit, or a coverage call, about Zepbound (tirzepatide). Note which approved use applies to you, the doses your prescriber lists, and the questions you need answered.

Companion to “Zepbound Regulatory Status: US, EU, Canada, and UK Approvals for Tirzepatide” · healthrx.com/zepbound/regulatory-status-global · Facts checked Nov 10, 2026

My prescription details

Copy these from your prescription label, medication list or insurer letter.

Approved use my prescriber listsWeight management, sleep apnea, or other, in your own words
Diagnosis or condition listedWrite the condition the prescriber recorded

Gather before the visit

Bring copies, not originals, where you can.

  • Bring your current medication list with all supplements and other prescriptions
  • Write down any personal or family history of thyroid conditions to share with your prescriber
  • Bring your insurer card and any prior authorization letters
  • Note the label wording for the approved use printed on your box or leaflet
  • Check with your pharmacist which strength is currently in stock
  • Bring a list of past doses you have tried and how long you stayed on each
  • Note any other weight-related or sleep-related conditions your prescriber has recorded

Questions to ask

  1. Which approved use does my prescription fall under?
  2. Is my diagnosis one the label covers for this medicine?
  3. Does my plan require prior authorization, and what documents does it need?
  4. Am I on the start dose, a maintenance dose, or a step in between?
  5. When could my dose change, and who will decide it?
  6. Is my thyroid history checked before I continue?
  7. What would make my coverage stop, and how would I be told?
  8. Can you explain the difference between this medicine and the other one I was offered?

Dose and coverage tracking

Record each refill, dose change and insurer contact.

DateDose or eventWho I spoke withNext step

This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.