Employer / Commercial Insurance
Covered with requirementsWhat you need to qualify
- Age 18 and older
- BMI of 30 or higher
- Diagnosed obstructive sleep apnea
Qualification pathways
You can qualify through any one of these.
Moderate to severe OSA in adults with obesity
All of:
- Adult patient (age >= 18)
- Diagnosis of moderate to severe obstructive sleep apnea (OSA)
- Obesity (BMI >= 30 kg/m2)
Documentation to bring
- Documentation of moderate to severe OSA diagnosis
- Documentation of obesity (BMI >= 30 kg/m2)
Not covered when
- Coadministration with other tirzepatide-containing products is not recommended
- Coadministration with any GLP-1 receptor agonist is not recommended
Policy note: FDA indication listed as moderate to severe OSA in adults with obesity. Specific AHI threshold, PAP trial requirement, and other OSA-specific PA criteria are not enumerated in the provided document text — only the FDA indication summary is presented. Document does not specify 'moderate to severe' in terms of AHI cutoff values.
Policy effective April 20, 2026 · verified June 2, 2026 · source: ND_Weight_Management_PAQL_ProgSum.pdf