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Nevada Medicaid

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

Yes. Nevada 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 3, 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 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
  • Renewal: 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 · View policy document (PDF)

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Questions people ask
Does Nevada Medicaid cover Zepbound?
Yes. Nevada 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 Nevada Medicaid?
Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Nevada Medicaid require to renew Zepbound?
Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. 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.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Nevada Medicaid: Mounjaro, Ozempic, Wegovy

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

All insurance plans · All medications

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