Employer / Commercial Insurance
Covered with requirementsWhat you need to qualify
- Age 18 and older
- BMI of 30 or higher
- Diagnosed obstructive sleep apnea (AHI of 15 or higher)
Qualification pathways
You can qualify through any one of these.
Moderate to severe OSA with obesity
All of:
- Adult (age >= 18 years)
- BMI >= 30 kg/m2 (obesity)
- Diagnosis of moderate to severe OSA (AHI >= 15 events/hour or REI/RDI equivalent per PSG or HSAT)
Plus any one of:
- Patient not currently receiving PAP therapy
- Patient currently receiving PAP therapy (both populations studied in SURMOUNT-OSA)
Documentation to bring
- Diagnosis of moderate to severe OSA confirmed by polysomnography (PSG) or home sleep apnea testing (HSAT)
- AHI, REI, or RDI result documenting moderate to severe OSA (AHI >= 15 events/hour)
- Baseline BMI >= 30 kg/m2 (obesity)
- Age >= 18 years
Not covered when
- Craniofacial abnormalities affecting respiration (per SURMOUNT-OSA exclusion criteria)
- Predominantly central or mixed sleep apnea (>= 50% central or mixed apneas/hypopneas)
- Cheyne-Stokes respiration
- Obesity hypoventilation syndrome
- Evidence of daytime hypercapnia
- Coadministration with other tirzepatide-containing products not recommended
- Coadministration with any GLP-1 receptor agonist not recommended
Policy note: FDA indication is for moderate to severe OSA in adults with obesity. The SURMOUNT-OSA program (two Phase 3 trials) enrolled participants with mean AHI ~50 events/hour and mean BMI ~39 kg/m2. Trial 1 enrolled patients not on PAP therapy; Trial 2 enrolled patients on PAP therapy. The document notes AHI from PSG is the preferred diagnostic index; REI (HSAT-based) is acceptable surrogate but may underestimate severity; RDI may identify arousal-based disease. PAP therapy trial is NOT required as a prerequisite per the clinical rationale. OSA AHI minimum set to 15 events/hour based on the definition of moderate OSA (the FDA indication requires 'moderate to severe'). AASM recommended hypopnea scoring: >= 3% oxygen desaturation and/or arousal.
Policy effective May 4, 2026 · verified June 2, 2026 · source: RI_Weight_Management_ProgSum.pdf