How long does a Zepbound approval last with Oregon Medicaid?

Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.

What does Oregon Medicaid require to renew Zepbound?

Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. At least 5% reduction in BMI. At renewal for OSA (step 5-8): patient must have lost or maintained a BMI reduction of 5% or more, been adherent to therapy per provider attestation, and be continuing with a weight loss treatment plan (diet/exercise, nutritional counseling, and/or calorie restricted diet). BMI, OSA diagnosis, and T2DM screening are not re-verified at renewal.

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.

Oregon Medicaid coverage for Zepbound (Obstructive

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

Yes. Oregon 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

Oregon%20 Medicaid%20 PA%20 Criteria%20 Guide%20 %20 June%201%2 C%202026

Oregon Medicaid · PA policy · Medicaid

Effective March 1, 2026. Verified June 4, 2026.

View PDF Download Original insurer source

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.

OSA — Moderate to Severe OSA with Obesity

All of:

Patient is an adult (implied: 18 years or older based on Table 3 and approval criteria flow)
BMI of 30 kg/m2 or greater (obesity)
Moderate to severe obstructive sleep apnea (OSA): AHI of 15 events/hour or more
Prior weight loss treatment plan administered by a health care provider for at least 3 months within the previous 6-month timeframe
Patient will be engaged in a weight management lifestyle modification program in addition to pharmacotherapy
Patient has been screened for diabetes within the past year with results indicating no diabetes (HbA1c <6.5% or fasting blood glucose <126 mg/dL) OR has a documented type 2 diabetes diagnosis

Documentation to bring

ICD-10 diagnosis code for the condition being treated
Documentation of obesity (BMI ≥30 kg/m2)
Documentation of moderate to severe OSA diagnosis with AHI ≥15 events/hour
Documentation of prior weight loss treatment plan administered by a health care provider for at least 3 months within the previous 6-month timeframe
Documentation of type 2 diabetes diagnosis OR diabetes screening results within the past year (HbA1c <6.5% or fasting blood glucose <126 mg/dL)
Attestation that patient will be engaged in a weight management lifestyle modification program

Approval and renewal

Initial approval: 6 months
Renewal: every 12 months
Renewal: At least 5% reduction in BMI.
Renewal: At renewal for OSA (step 5-8): patient must have lost or maintained a BMI reduction of 5% or more, been adherent to therapy per provider attestation, and be continuing with a weight loss treatment plan (diet/exercise, nutritional counseling, and/or calorie restricted diet). BMI, OSA diagnosis, and T2DM screening are not re-verified at renewal.

Policy note: Moderate OSA defined as AHI ≥15 events/hour; severe OSA defined as AHI ≥30 events/hour. The document does not require PAP therapy trial prior to approval. The OSA approval pathway flows through the Table 3 evidence-supported indications check (step 12) and then step 13 (lifestyle program), step 14/15 (diabetes screening), and step 16/17 (Zepbound-specific OSA criteria). The document states 'Tirzepatide is not currently covered for adults who do not have established obstructive sleep apnea or type 2 diabetes.' No PAP/CPAP trial requirement was stated.

Policy effective March 1, 2026 · verified June 4, 2026 · source: Oregon%20 Medicaid%20 PA%20 Criteria%20 Guide%20 %20 June%201%2 C%202026 · View policy document (PDF)

Open on its own page →

Questions people ask

Does Oregon Medicaid cover Zepbound?: Yes. Oregon 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 Oregon Medicaid?: Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.
What does Oregon Medicaid require to renew Zepbound?: Obstructive Sleep Apnea (OSA) — Applies to Medicaid plans. At least 5% reduction in BMI. At renewal for OSA (step 5-8): patient must have lost or maintained a BMI reduction of 5% or more, been adherent to therapy per provider attestation, and be continuing with a weight loss treatment plan (diet/exercise, nutritional counseling, and/or calorie restricted diet). BMI, OSA diagnosis, and T2DM screening are not re-verified at renewal.
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.

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