Molina Healthcare · Osa

Molina Healthcare coverage for Zepbound (Osa)

Medicaid

Not covered

Zepbound (tirzepatide) is considered a benefit exclusion for all indications in states where weight loss drugs are a benefit exclusion, explicitly including 'weight reduction to treat moderate to severe obstructive sleep apnea.' The policy states this exclusion applies to 'all indications, including but not limited to weight reduction and chronic weight management, weight reduction to treat moderate to severe obstructive sleep apnea, and so on.'

Exceptions

California_Marketplace: State-specific exception may apply; see Weight Management Therapy CA MMKP C28425-A for criteria.
New_Mexico_Marketplace: State-specific exception may apply; see Weight Management Therapy NM MMKP C29220-A for criteria.

Policy note: The OSA indication for Zepbound is explicitly captured within the benefit exclusion language ('including but not limited to ... weight reduction to treat moderate to severe obstructive sleep apnea'). The mechanism of action for OSA is weight loss per the policy's background section. The clinical trial (NCT05412004) excluded patients with type 2 diabetes mellitus. The policy does not establish any affirmative coverage criteria because the drug is excluded. Policy number C29112-A. Original effective date 03/28/2025; revised Q4 2025.

Policy effective December 11, 2025 · verified June 11, 2026 · source: Pa policy

ACA Marketplace

Not covered

In states where weight loss drugs are a benefit exclusion, Zepbound (tirzepatide) is considered a benefit exclusion for all indications, including but not limited to weight reduction and chronic weight management, weight reduction to treat moderate to severe obstructive sleep apnea, and so on. Weight loss drugs are benefit exclusions as outlined in the Marketplace Evidence of Coverage.

Exceptions

California_Marketplace: See Weight Management Therapy CA MMKP C28425-A for any applicable state-specific coverage criteria.
New_Mexico_Marketplace: See Weight Management Therapy NM MMKP C29220-A for any applicable state-specific coverage criteria.

Policy note: The OSA indication is explicitly grouped with weight loss indications and excluded under the same benefit exclusion language. The document states the exclusion applies to 'all indications, including but not limited to weight reduction and chronic weight management, weight reduction to treat moderate to severe obstructive sleep apnea.' The policy's 'REQUIRED MEDICAL INFORMATION' section contains only exclusion criteria and no coverage criteria, confirming this is a blanket exclusion policy for this plan type.

Policy effective December 11, 2025 · verified June 11, 2026 · source: ED2C6F09F1D84EF1A25C2592FCA62739.ashx

All Zepbound policies under Molina Healthcare · Check your card