Connecticut Medicaid

Does Connecticut Medicaid cover Zepbound?

Quick answer · Osa

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

  • Medicaid: Covered with requirements. Diagnosis documented with a code (G4733)

Last verified June 3, 2026. Policy effective July 1, 2025. Source: Get-Download-File. How we verify this data →

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Zepbound for Osa

What Connecticut 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
  • Diagnosis documented with a code (G4733)
  • 6 months of a documented diet and exercise program
  • Diagnosed obstructive sleep apnea (AHI of 15 or higher)

Qualification pathways

You can qualify through any one of these.

Initial and Annual Authorization for OSA

All of:

  • Established diagnosis of obstructive sleep apnea (OSA) with AHI >= 15
  • Member is 18 years of age or older
  • Currently using AND will continue to use positive airway pressure (PAP) treatment, unless a contraindication to PAP exists
  • Active participation in comprehensive adjunct lifestyle interventions (diet modifications, physical activity, nutritional counseling, and/or behavioral therapy)
  • Diagnosis code G4733 submitted on pharmacy claim in Field 424-DO
  • Prescriber completes and submits the Zepbound for Treatment of Obstructive Sleep Apnea PA form with all required information

Documentation to bring

  • Completed Zepbound for Treatment of Obstructive Sleep Apnea Prior Authorization Form (available at www.ctdssmap.com under Pharmacy Information tab)
  • Documentation of established OSA diagnosis including AHI >= 15
  • Documentation of current PAP therapy use (or documented contraindication to PAP)
  • Documentation of active participation in comprehensive adjunct lifestyle interventions (diet, physical activity, nutritional counseling, and/or behavioral therapy)
  • Diagnosis code G4733 submitted on pharmacy claim in Field 424-DO

Approval and renewal

  • Renewal: every 12 months

Policy note: PA is required at initiation of new therapy and annually thereafter. Reimbursed through the pharmacy benefit only. Dispensed under HUSKY Health Programs A, B, C, and D. PAP therapy is required unless a contraindication exists (not a prior-trial requirement — concurrent use is mandated). The bulletin does not specify quantity limits or initial approval duration; annual renewal is explicitly stated. Document does not address weight_loss indication for Zepbound.

Policy effective July 1, 2025 · verified June 3, 2026 · source: Get-Download-File

Why Zepbound requests get denied by Connecticut Medicaid

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

  1. 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.
  2. Diagnosis code missing or wrong on the request.
  3. No documented diet and exercise program.

Frequently asked questions

Does Connecticut Medicaid cover Zepbound?
Connecticut Medicaid covers Zepbound for osa with prior authorization on Medicaid.
How current is this information?
This page reflects Connecticut Medicaid's written policy as of July 1, 2025, last verified against the source document on June 3, 2026.

Other medications under Connecticut Medicaid

Zepbound coverage under other plans

All insurance plans · All medications

This page summarizes Connecticut 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.