What BMI do you need for Zepbound under Colorado Medicaid?

For osa on Medicaid plans, Colorado Medicaid requires a BMI of 30 or higher.

How current is this information?

This page reflects Colorado Medicaid's written policy as of March 1, 2023, last verified against the source document on June 4, 2026.

Colorado Medicaid

Does Colorado Medicaid cover Zepbound?

Find your Medicaid card name in Colorado

Quick answer · Osa

Colorado Medicaid covers Zepbound for osa with prior authorization on Medicaid.

Medicaid: Covered with requirements. BMI of 30 or higher

Last verified June 4, 2026. Policy effective March 1, 2023. Source: 04-01-26%20PDL%20V1.pdf. How we verify this data →

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Zepbound for Osa

What Colorado Medicaid requires, by plan type. Open this indication on its own page →

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, with a documented trial of PAP therapy

Policy note: Non-preferred. OSA: age >=18, BMI >=30 documented, OSA confirmed by approved sleep test, not pregnant, MTC/MEN2 counseling, engaged in lifestyle modification, AND failed a 6-month trial of CPAP. Reauthorization requires documented clinical improvement in OSA symptoms + adherence.

Policy effective March 1, 2023 · verified June 4, 2026 · source: 04-01-26%20PDL%20V1.pdf

Why Zepbound requests get denied by Colorado Medicaid

Based on what this policy asks for. Fix these before the first submission.

Wrong brand for the diagnosis. Zepbound and Mounjaro are the same molecule with different approved uses; a request for Zepbound under a diagnosis that matches Mounjaro is routinely denied.
Diagnosis code missing or wrong on the request.
BMI not documented in the chart notes (or documented without a baseline weight and date).

Frequently asked questions

Does Colorado Medicaid cover Zepbound?: Colorado Medicaid covers Zepbound for osa with prior authorization on Medicaid.
What BMI do you need for Zepbound under Colorado Medicaid?: For osa on Medicaid plans, Colorado Medicaid requires a BMI of 30 or higher.
How current is this information?: This page reflects Colorado Medicaid's written policy as of March 1, 2023, last verified against the source document on June 4, 2026.

Other medications under Colorado Medicaid

Zepbound coverage under other plans

All insurance plans · All medications

This page summarizes Colorado Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.