Maryland Medicaid coverage for Zepbound (Osa)

What you need to qualify

• Age 18 and older
• BMI of 30 or higher
• Prescribed by or in consultation with a specialist
• Diagnosed obstructive sleep apnea (AHI of 15 or higher)

Qualification pathways

You can qualify through any one of these.

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
• To renew, the plan looks for 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.html