Skip to content

New Hampshire Medicaid

Does New Hampshire Medicaid cover Zepbound?

Yes. New Hampshire Medicaid covers Zepbound for obstructive sleep apnea (OSA) with prior authorization if your BMI is 27 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.

Initial Approval — OSA with Obesity

All of:

  • Documented failure of at least a three-month trial on a low-calorie diet (1,200 kcal/day for women, 1,600 kcal/day for men)
  • Regimen of increased physical activity including strength training to prevent lean muscle loss (unless medically contraindicated by comorbidity)
  • Baseline BMI ≥ 27 kg/m²
  • Diagnosis of moderate-to-severe OSA confirmed by AHI ≥ 15 on in-lab attended sleep study or polysomnography (PSG)
  • Patient has been adherent to PAP therapy at least 70% of the time in the last 6 months and will continue PAP in combination with tirzepatide (unless intolerant or other rationale provided)
  • Patient does not have a diagnosis of Type 1 or Type 2 Diabetes Mellitus

Renewal — Ongoing OSA Treatment

All of:

  • Ongoing prescriber documentation of adherence to low-calorie diet (1,200 kcal/day for women, 1,600 kcal/day for men)
  • Ongoing regimen of increased physical activity and strength training (unless medically contraindicated by comorbidity)
  • Ongoing adherence to PAP therapy
  • Patient has not experienced any treatment-restricting adverse effects (e.g., diarrhea, nausea, vomiting, GERD)

Documentation to bring

  • Documentation of failure of at least a 3-month low-calorie diet trial (1,200 kcal/day for women, 1,600 kcal/day for men)
  • Documentation of current regimen of increased physical activity including strength training, or medical contraindication
  • Baseline BMI measurement ≥ 27 kg/m²
  • Sleep study or polysomnography (PSG) results confirming AHI ≥ 15 (moderate-to-severe OSA)
  • Documentation of PAP therapy adherence ≥ 70% over the last 6 months, or documentation of PAP intolerance or clinical rationale for non-use
  • Confirmation that patient does not have a diagnosis of Type 1 or Type 2 Diabetes Mellitus
  • For renewal: prescriber attestation of ongoing diet and exercise adherence
  • For renewal: documentation of ongoing PAP therapy adherence
  • For renewal: documentation of absence of treatment-restricting adverse effects

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: Ongoing prescriber documentation of adherence to low-calorie diet (1,200 kcal/day for women, 1,600 kcal/day for men); ongoing regimen of increased physical activity and strength training (unless medically contraindicated); ongoing adherence to PAP therapy; no treatment-restricting adverse effects (e.g., diarrhea, nausea, vomiting, GERD). Note: initial BMI threshold, OSA diagnosis confirmation, PAP prior trial, and diabetes exclusion are not explicitly re-verified at renewal — only ongoing adherence to diet, exercise, and PAP therapy is required.

Not covered when

  • Type 2 Diabetes Mellitus (patient must not have diagnosis of T1DM or T2DM)
  • Use solely for chronic weight management (not OSA) is denied
  • Type 1 diabetes

Policy note: This policy is specific to New Hampshire Medicaid Fee-for-Service and was administered/drafted by Prime Therapeutics. OSA must be moderate-to-severe (AHI ≥ 15). PAP adherence is defined as ≥ 70% over the last 6 months; exceptions allowed for documented PAP intolerance or other provided rationale. The policy explicitly excludes both T1DM and T2DM patients. Claims solely for chronic weight management (without OSA indication) will be denied. Dosage forms listed: 2.5 mg/0.5 mL, 5 mg/0.5 mL, 7.5 mg/0.5 mL, 10 mg/0.5 mL, 12.5 mg/0.5 mL, 15 mg/0.5 mL. No quantity limits specified in this document.

Policy effective October 1, 2025 · verified June 4, 2026 · source: E0959ae6 9462 96ed F65f 513497f0cd3c · View policy document (PDF)

Open on its own page →

Questions people ask
Does New Hampshire Medicaid cover Zepbound?
Yes. New Hampshire Medicaid covers Zepbound for obstructive sleep apnea (OSA) with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Zepbound approval last with New Hampshire Medicaid?
Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.
What does New Hampshire Medicaid require to renew Zepbound?
Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. Ongoing prescriber documentation of adherence to low-calorie diet (1,200 kcal/day for women, 1,600 kcal/day for men); ongoing regimen of increased physical activity and strength training (unless medically contraindicated); ongoing adherence to PAP therapy; no treatment-restricting adverse effects (e.g., diarrhea, nausea, vomiting, GERD). Note: initial BMI threshold, OSA diagnosis confirmation, PAP prior trial, and diabetes exclusion are not explicitly re-verified at renewal — only ongoing adherence to diet, exercise, and PAP therapy is required.
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 New Hampshire Medicaid: Mounjaro, Ozempic, Wegovy

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

All insurance plans · All medications

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