Medicaid
Covered with requirementsWhat you need to qualify
- Age 18 and older
- BMI of 30 or higher
- Diagnosed obstructive sleep apnea (AHI of 5 or higher)
- Not being used to treat type 1 diabetes
Qualification pathways
You can qualify through any one of these.
OSA with obesity - AHI >= 15 (moderate to severe)
All of:
- Adult age >= 18 years
- BMI > 30 kg/m2
- Moderate to severe OSA in adults with obesity
- 15 or more obstructive respiratory events per hour of sleep confirmed by sleep study from certified or accredited sleep disorder facility
- No type 1 or type 2 diabetes
- No contraindications to Zepbound
- Full compliance with ongoing treatment for underlying airway obstruction (e.g., CPAP, BiPAP) unless provider rationale for why not indicated
- Provider attestation medication used with reduced calorie diet and increased physical activity
OSA with obesity - AHI >= 5 with symptoms (mild to moderate)
All of:
- Adult age >= 18 years
- BMI > 30 kg/m2
- Moderate to severe OSA in adults with obesity
- 5 or more obstructive respiratory events per hour of sleep confirmed by sleep study from certified or accredited sleep disorder facility
- No type 1 or type 2 diabetes
- No contraindications to Zepbound
- Full compliance with ongoing treatment for underlying airway obstruction (e.g., CPAP, BiPAP) unless provider rationale for why not indicated
- Provider attestation medication used with reduced calorie diet and increased physical activity
Plus any one of:
- Daytime sleepiness
- Nonrestorative sleep
- Fatigue
- Insomnia
- Waking up with breath holding, gasping, or choking
- Habitual snoring noted by bed partner or other observer
- Observed apnea
OSA with obesity - Unable to undergo facility sleep study
All of:
- Adult age >= 18 years
- BMI > 30 kg/m2
- Moderate to severe OSA in adults with obesity
- Recipient is not an appropriate candidate for a facility sleep study due to immobility, safety, or critical illness
- Zepbound prescribed by or in consultation with a board-certified sleep specialist or pulmonologist for diagnosis of moderate to severe OSA
- No type 1 or type 2 diabetes
- No contraindications to Zepbound
- Full compliance with ongoing treatment for underlying airway obstruction (e.g., CPAP, BiPAP) unless provider rationale for why not indicated
- Provider attestation medication used with reduced calorie diet and increased physical activity
Documentation to bring
- Documentation of BMI > 30 kg/m2
- Submission of sleep study records confirming OSA from a certified or accredited sleep disorder facility (for pathways 1 and 2), OR documentation that facility sleep study is not appropriate with specialist consultation (pathway 3)
- Documentation of AHI (obstructive respiratory events per hour of sleep)
- Documentation of qualifying OSA symptoms if AHI is 5-14 (pathway 2)
- Board-certified sleep specialist or pulmonologist consultation if facility sleep study not feasible (pathway 3)
- Confirmation recipient has no type 1 or type 2 diabetes
- Confirmation of no contraindications to Zepbound
- Documentation of compliance with CPAP/BiPAP or provider rationale for why PAP therapy is not indicated
- Provider attestation that medication will be used with reduced calorie diet and increased physical activity
Approval and renewal
- Initial approval: 6 months
- Renewal: every 6 months
- To renew, the plan looks for Documentation of positive clinical response to therapy; recipient continues to be fully compliant with ongoing PAP/BiPAP treatment for underlying airway obstruction (unless provider rationale given why not indicated). T2DM exclusion and BMI requirement not explicitly re-checked at continuation.
Not covered when
- Type 2 diabetes (this OSA indication is specific to non-diabetic recipients)
- Any contraindications to Zepbound use
- Type 1 diabetes
Policy note: osa_ahi_min is set to 5 reflecting the minimum AHI threshold in any qualifying pathway (pathway 2 allows AHI >= 5 with symptoms). Pathway 1 requires AHI >= 15 without additional symptom requirement. PAP therapy (CPAP/BiPAP) compliance is required ongoing but is NOT a prior trial requirement for initial approval — it must be ongoing concurrent treatment. Policy requires submission of records (sleep study records). Recertification at 6 months requires positive clinical response and continued PAP compliance. Both T1DM and T2DM are explicitly excluded — this indication is for non-diabetic patients only.
Policy effective April 6, 2026 · verified June 3, 2026 · source: msm_1200_26_04_06.pdf