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As of April 2026, Zepbound (tirzepatide) appears on the formulary with the following restrictions: Covered indications: Type 2 diabetes mellitus as an adjunct to diet and exercise Must be prescribed by a TRICARE-authorized provider Requires prior authorization regardless of plan type Subject to step therapy requirements (metformin, sulfonylureas, or other first-line agents must be tried first) Excluded indications: Obesity or weight management in patients without type 2 diabetes Overweight status (BMI 25 to 29.9) Metabolic syndrome without diagnosed diabetes Prediabetes (HbA1c 5.7% to 6.4%) Cardiovascular risk reduction in non-diabetic patients The distinction matters because Zepbound is FDA-approved for both chronic weight management (approved December 2023) and type 2 diabetes (approved May 2022 under the brand name Mounjaro)

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Insulin sensitivity pilot study (Ruggenenti): A pilot study in nondiabetic subjects at increased cardiovascular risk with insulin resistance found that 2 g/day of oral ALCAR for 6 months improved insulin-mediated glucose disposal (measured by euglycemic hyperinsulinemic clamp) alongside reductions in blood pressure [5][21]

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