California Medicaid coverage for Zepbound (Osa)

Medicaid

Covered with requirements

What you need to qualify

Diagnosed obstructive sleep apnea

Qualification pathways

You can qualify through any one of these.

OSA indication — PA considered

All of:

Obstructive sleep apnea (OSA) diagnosis

Documentation to bring

PA request for obstructive sleep apnea (OSA) indication

Policy note: Document states 'PA requests for Zepbound will be considered when used for obstructive sleep apnea (OSA).' No specific clinical criteria (AHI threshold, PAP trial, etc.) are defined in this document. Detailed criteria are presumably addressed elsewhere. Claims otherwise deny with Reject Code 70.

Policy effective April 6, 2026 · verified June 3, 2026 · source: 12_A_GLP-1_Coverage_Considerations.pdf