You can qualify through any one of these.
Moderate-to-Severe OSA with Obesity — Current AHI >=15
All of:
- Member is 18 years of age or older
- Diagnosis of moderate to severe OSA (AHI >=15 events/hour) in individuals with obesity
- Documented BMI >= 30 kg/m2 with baseline weight before initiating Zepbound (chart documentation within past 3 months)
- AHI >=15 events/hour on PSG or HSAT reviewed and interpreted by sleep medicine-certified physician (documentation from study obtained within past year)
- Member does not have Type 1 or Type 2 diabetes mellitus
- HbA1c < 6.5% (chart documentation within past 3 months)
- No diagnosis of central or mixed sleep apnea with >=50% mixed/central apneas/hypopneas (prescriber attestation)
- Member will use in combination with reduced calorie diet and increased physical activity
- No concurrent use with another GLP-1 RA or combination product (including tirzepatide-containing products)
- Dose does not exceed 15 mg/week
Moderate-to-Severe OSA with Obesity — Prior AHI >=15 on PAP Therapy
All of:
- Member is 18 years of age or older
- Diagnosis of moderate to severe OSA (AHI >=15 events/hour) in individuals with obesity
- Documented BMI >= 30 kg/m2 with baseline weight before initiating Zepbound (chart documentation within past 3 months)
- Prior AHI >=15 events/hour on PSG or HSAT reviewed and interpreted by sleep medicine-certified physician (documentation required)
- Member does not have Type 1 or Type 2 diabetes mellitus
- HbA1c < 6.5% (chart documentation within past 3 months)
- No diagnosis of central or mixed sleep apnea with >=50% mixed/central apneas/hypopneas (prescriber attestation)
- Member will use in combination with reduced calorie diet and increased physical activity
- No concurrent use with another GLP-1 RA or combination product (including tirzepatide-containing products)
- Dose does not exceed 15 mg/week
Plus any one of:
- Currently utilizing PAP therapy (CPAP or BiPAP) with documented adherence within past 90 days (>=4 hours/night for >=70% of nights in a 30-day period, supported by PAP therapy report or chart note)
- Prescriber has provided valid medical justification why member cannot use PAP therapy (e.g., intellectual disabilities)
Policy effective July 1, 2026 · verified June 4, 2026 · source: 20260701_Public-Facing_GLP-1%20RA-GIP-Combinations_PA_Final.pdf