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Maryland Medicaid

Does Maryland Medicaid cover Zepbound?

Yes. Maryland 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

  • 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.

OSA Initial Approval

All of:

  • Age ≥ 18 years
  • BMI ≥ 30 kg/m2
  • Moderate to severe OSA diagnosed by polysomnography or home sleep study with AHI ≥ 15 events per hour
  • Prescribed by or in consultation with a sleep specialist, pulmonologist, or other provider experienced in treating OSA
  • Current height and weight measurements within the last 90 days
  • Patient meets FDA-approved prescribing information clinical parameters (no contraindications, appropriate screening and monitoring completed)
  • Will not be used concurrently with other tirzepatide-containing products or GLP-1 receptor agonists

Documentation to bring

  • Prescription from or documentation of consultation with a sleep specialist, pulmonologist, or other provider experienced in treating OSA
  • Polysomnography or home sleep study results showing AHI ≥ 15 events per hour
  • Current height and weight measurements within the last 90 days confirming BMI ≥ 30 kg/m2
  • Prescriber attestation that patient meets FDA-approved prescribing information clinical parameters (no contraindications, appropriate screening and monitoring)

Quantity limits

  • any strength — 4 pens/28 days

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Prescriber attestation of continued clinical benefit and subsequent evaluation and monitoring performed. BMI must remain ≥ 30 kg/m2. After 12 months, repeat documentation via polysomnography, sleep study, or CPAP data confirming moderate to severe OSA is required, and annually thereafter.

Not covered when

  • Concurrent use of other tirzepatide-containing products
  • Concurrent use of GLP-1 receptor agonists
  • BMI < 30 kg/m2 (renewal denial)

Policy note: Therapy beyond 12 months requires repeat documentation (via polysomnography, sleep study, or CPAP data) confirming moderate to severe OSA, and annually thereafter. Renewal will NOT be authorized if BMI < 30 kg/m2.

verified June 4, 2026 · source: Policy 368 · View policy document (PDF)

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Questions people ask
Does Maryland Medicaid cover Zepbound?
Yes. Maryland 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 Maryland Medicaid?
Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Maryland Medicaid require to renew Zepbound?
Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. Prescriber attestation of continued clinical benefit and subsequent evaluation and monitoring performed. BMI must remain ≥ 30 kg/m2. After 12 months, repeat documentation via polysomnography, sleep study, or CPAP data confirming moderate to severe OSA is required, and annually thereafter.
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 Maryland Medicaid: Wegovy

Zepbound under other plans: Kaiser Permanente Mid-Atlantic, Alabama Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, Illinois Medicaid, Indiana Medicaid

All insurance plans · All medications

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