Alabama Medicaid coverage for Zepbound (Osa)

Medicaid

Covered with requirements

What you need to qualify

Age 18 and older
BMI of 30 or higher
Diagnosis documented with a code
Diagnosed obstructive sleep apnea (AHI of 15 or higher)
Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

OSA indication — initial approval

All of:

Patient is 18 years of age or older
Diagnosis of moderate to severe obstructive sleep apnea (AHI >= 15)
Obesity (BMI >= 30 kg/m²)
No diagnosis of diabetes
Patient has been counseled to continue a reduced-calorie diet and increased physical activity
Not taking this medication in combination with another GLP-1 agonist

Documentation to bring

Documentation of patient age >= 18 years
Documentation of moderate to severe obstructive sleep apnea diagnosis (AHI >= 15)
Documentation of obesity (BMI >= 30 kg/m²)
Documentation confirming no diagnosis of diabetes
Documentation that patient has been counseled on reduced-calorie diet and increased physical activity
Confirmation that patient is not taking medication in combination with another GLP-1 agonist

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months

Not covered when

Patients with a diagnosis of diabetes are excluded from OSA indication
Combination use with another GLP-1 agonist is excluded
Stable therapy pathway does not apply to OSA indication

Policy note: The document explicitly states 'Stable therapy does not apply' for the OSA indication. The standard prior treatment trial requirement (failed 30-day trials with two preferred agents) does not appear to be applied to the OSA indication — this indication has its own specific criteria set out separately. The step-therapy / prior treatment trial language appears to apply to the diabetes indication for the class; OSA criteria are specified independently.

Policy effective August 15, 2025 · verified June 3, 2026 · source: Pa policy