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Indiana Medicaid

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

Yes. Indiana Medicaid covers Zepbound for obstructive sleep apnea (OSA) with prior authorization if your BMI is 30 or higher. Other policy requirements and your plan's benefits also apply.

Policy document

  • 20260701 Public Facing GLP-1%20 Ra Gip Combinations PA Final

    Indiana Medicaid · PA policy · Medicaid

    Effective July 1, 2026. Verified June 4, 2026.

    View PDF Download Original insurer source
  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 4, 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.

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)

Documentation to bring

  • Chart documentation confirming BMI ≥ 30 kg/m2 and baseline weight obtained within past 3 months
  • PSG or HSAT report with AHI ≥15 events/hour reviewed and interpreted by sleep medicine-certified physician (obtained within past year), OR prior PSG/HSAT report with AHI ≥15 plus PAP therapy adherence documentation or medical justification for PAP inability
  • HbA1c lab result < 6.5% obtained within past 3 months
  • Prescriber attestation of no T1D or T2D diagnosis
  • Prescriber attestation of no central or mixed sleep apnea (≥50% mixed/central apneas/hypopneas)
  • PAP therapy adherence report (within past 90 days showing ≥4 hours/night for ≥70% of nights in 30-day period) if using the PAP pathway, OR prescriber medical justification for PAP inability
  • Prescriber attestation of diet/physical activity use
  • Prescriber attestation of no concurrent GLP-1 RA or tirzepatide-containing products

Quantity limits

  • all strengths — max 15 mg/week

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: At first reauthorization (therapy >1 year and <2 years): documented reduction in AHI from baseline (PSG, HSAT, or CPAP/BiPAP sleep data obtained within past 3 months). At all reauthorizations: documented meaningful weight loss of at least 5% from baseline, prescriber attests no T1D or T2D, prescriber attests no central or mixed sleep apnea diagnosis, no concurrent GLP-1 RA or tirzepatide-containing products, dose does not exceed 15 mg/week, history of requested agent at least 84 days within past 112 days.
  • Renewal: At least 12 weeks on therapy before the first renewal.

Not covered when

  • Type 2 diabetes excluded
  • HbA1c ≥6.5% excluded
  • Central or mixed sleep apnea with ≥50% mixed/central apneas/hypopneas excluded
  • No concurrent use with another GLP-1 RA or combination product including tirzepatide-containing products
  • Dose must not exceed 15 mg/week
  • Weight loss as the sole indication is explicitly not covered
  • Type 1 diabetes

Policy note: Document states 'ZEPBOUND (TIRZEPATIDE) (NOT COVERED EXCLUSIVELY FOR WEIGHT LOSS).' OSA-only indication: members must NOT have T1D or T2D and must have HbA1c <6.5%. Two pathways: (1) current PSG/HSAT with AHI ≥15 within past year; (2) prior PSG/HSAT with AHI ≥15 and current PAP therapy adherence or medical justification for PAP non-use. PAP adherence defined as ≥4 hours/night for ≥70% of nights within a 30-day period. At first renewal only (therapy 1-2 years), AHI reduction from baseline must be documented. At ALL renewals, ≥5% weight loss from baseline required. Specialist required: sleep medicine-certified physician must review and interpret the diagnostic sleep study.

Policy effective July 1, 2026 · verified June 4, 2026 · source: 20260701 Public Facing GLP-1%20 Ra Gip Combinations PA Final · View policy document (PDF)

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Questions people ask
Does Indiana Medicaid cover Zepbound?
Yes. Indiana Medicaid covers Zepbound for obstructive sleep apnea (OSA) with prior authorization if your BMI is 30 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Zepbound approval last with Indiana Medicaid?
Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Indiana Medicaid require to renew Zepbound?
Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. At first reauthorization (therapy >1 year and <2 years): documented reduction in AHI from baseline (PSG, HSAT, or CPAP/BiPAP sleep data obtained within past 3 months). At all reauthorizations: documented meaningful weight loss of at least 5% from baseline, prescriber attests no T1D or T2D, prescriber attests no central or mixed sleep apnea diagnosis, no concurrent GLP-1 RA or tirzepatide-containing products, dose does not exceed 15 mg/week, history of requested agent at least 84 days within past 112 days. At least 12 weeks on therapy before the first renewal.
How current is this information?
The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Indiana Medicaid: Mounjaro, Ozempic, Wegovy

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

All insurance plans · All medications

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