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California Medicaid

Does California Medicaid cover Zepbound for Obstructive Sleep Apnea (OSA)?

Yes. California Medicaid covers Zepbound for obstructive sleep apnea (OSA) with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Zepbound for Obstructive Sleep Apnea (OSA) (1 plan type)

Applies to Medicaid plans.

Covered with requirements

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 · View policy document (PDF)

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Questions people ask
Does California Medicaid cover Zepbound?
Yes. California Medicaid covers Zepbound for obstructive sleep apnea (OSA) with prior authorization. Other policy requirements and your plan's benefits also apply.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under California Medicaid: Mounjaro, Ozempic, Wegovy

Zepbound under other plans: Elevance Health, Kaiser Permanente Northern California, Kaiser Permanente Southern California, Molina Healthcare, Alabama Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid

All insurance plans · All medications

Summary of California Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.