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Connecticut Medicaid

Does Connecticut Medicaid cover Zepbound?

Yes. Connecticut 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.

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 · View policy document (PDF)

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Questions people ask
Does Connecticut Medicaid cover Zepbound?
Yes. Connecticut Medicaid covers Zepbound for obstructive sleep apnea (OSA) with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Zepbound approval last with Connecticut Medicaid?
Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. Renewal: every 12 months.
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 Connecticut Medicaid: Mounjaro, Ozempic, Wegovy

Zepbound under other plans: Elevance Health, Alabama Medicaid, California Medicaid, Colorado Medicaid, Delaware Medicaid, Illinois Medicaid, Indiana Medicaid, Iowa Medicaid

All insurance plans · All medications

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