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Regence

Does Regence cover Zepbound?

It depends on your benefits. Regence covers Zepbound for weight loss only when your plan includes that benefit and the policy requirements are met.

Policy documents

  • Employer: Depends on your plan's benefit. See the qualification pathways below.
  • ACA Marketplace: Depends on your plan's benefit. See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Zepbound for Weight Loss (2 plan types)

Applies to Employer plans.

Depends on your plan's benefit

Coverage requires that the member benefit contract allows for coverage of medications for weight loss in obesity/overweight; weight loss must NOT be excluded from the pharmacy benefit

Qualification pathways

You can qualify through any one of these.

Adults with obesity

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age ≥ 18 years
  • BMI ≥ 30 kg/m2
  • Attestation medication will be used with lifestyle modification

Adults with overweight and comorbidity

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age ≥ 18 years
  • BMI ≥ 27 kg/m2
  • Attestation medication will be used with lifestyle modification

Plus any one of:

  • Hypertension
  • Dyslipidemia
  • Type 2 diabetes mellitus
  • Pre-diabetes
  • Insulin resistance
  • Obstructive sleep apnea
  • Cardiovascular disease
  • Symptomatic arthritis of lower extremities

Continuation of therapy - established on therapy prior to current health plan membership

All of:

  • Patient was established on therapy prior to current health plan membership
  • Documentation that medication was covered by another health plan
  • Clinical benefit such as disease stability
  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight

Documentation to bring

  • Clinical documentation (e.g., chart notes) confirming BMI ≥ 30 kg/m2 (obesity) OR BMI ≥ 27 kg/m2 with at least one weight-related comorbid condition (overweight)
  • Attestation that medication will be used concomitantly with lifestyle modification
  • For continuation: attestation of ≥ 5% body weight reduction from pretreatment baseline OR documentation that dose is currently being titrated upwards

Quantity limits

  • all strengths — 4 pens per 28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Adults (≥18 years): ≥ 5% body weight reduction from pretreatment baseline OR dose currently being titrated upwards. Attestation required that medication continues to be used with lifestyle modification. Benefit contract coverage eligibility re-verified at each renewal.

Not covered when

  • Co-administration with other weight loss medications (Contrave, Qsymia, or other GLP-1 agents in this policy) considered investigational
  • Used for type 2 diabetes without obesity or overweight — considered not medically necessary
  • Diabetic ketoacidosis (DKA)
  • Type 1 diabetes

Policy note: Policy covers Zepbound for weight loss in adults only (age ≥ 18); pediatric use of Zepbound is not included (only liraglutide/Saxenda and Wegovy are coverable for obesity in pediatrics per policy note). Coverage is gated on member benefit contract allowing weight loss medication coverage. Zepbound is NOT listed as a covered option for pediatric obesity in this policy.

Policy effective July 15, 2026 · verified July 16, 2026 · source: Dru787reg · View policy document (PDF)

Applies to ACA Marketplace plans.

Depends on your plan's benefit

Coverage requires that the member benefit contract allows for coverage of medications for weight loss in obesity/overweight. Not coverable when the member benefit contract excludes obesity/overweight treatments.

Qualification pathways

You can qualify through any one of these.

Adult obesity (≥18 years)

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age ≥ 18 years
  • BMI ≥ 30 kg/m2
  • Attestation that medication will be used with lifestyle modification

Adult overweight with comorbidity (≥18 years)

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age ≥ 18 years
  • BMI ≥ 27 kg/m2
  • Attestation that medication will be used with lifestyle modification

Plus any one of:

  • Hypertension
  • Dyslipidemia
  • Type 2 diabetes mellitus (T2DM)
  • Pre-diabetes
  • Insulin resistance
  • Obstructive sleep apnea (OSA)
  • Cardiovascular disease (CVD)
  • Symptomatic arthritis of lower extremities

Documentation to bring

  • Clinical documentation confirming BMI ≥ 30 kg/m2 (obesity) OR BMI ≥ 27 kg/m2 with at least one weight-related comorbid condition
  • Attestation that medication will be used with lifestyle modification (dietary/caloric restriction, exercise, weight management program, nutritional counseling, behavioral therapy)
  • Verification that member benefit contract allows coverage of medications for weight loss in obesity/overweight

Quantity limits

  • all strengths — 4 pens/28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Adults (≥18 years): ≥ 5% body weight reduction from pretreatment baseline OR dose currently being titrated upwards. Member benefit contract must continue to allow coverage. Attestation required that medication will continue to be used with lifestyle modification.

Not covered when

  • Co-administration with other medications for obesity or overweight (including Contrave, Qsymia) is considered investigational and not covered
  • Use for type 2 diabetes without obesity or overweight is considered not medically necessary
  • Zepbound is NOT coverable for obesity in pediatric patients (ages 12-17); only liraglutide generic/Saxenda and Wegovy are coverable in pediatrics
  • Type 1 diabetes

Policy note: Policy dru787 covers non-diabetic indications only. Mounjaro (tirzepatide for diabetes) is addressed in a separate policy (dru750). Zepbound is NOT listed as coverable for pediatric obesity (12-17 years) — only liraglutide and Wegovy are covered in that age group. The weight loss coverage for Zepbound requires the member benefit contract to allow weight loss medication coverage.

Policy effective March 15, 2026 · verified June 3, 2026 · source: Dru787reg · View policy document (PDF)

Open on its own page →

Full requirements: Zepbound for Obstructive Sleep Apnea (OSA) (2 plan types)

Applies to Employer plans.

Depends on your plan's benefit

Coverage requires that the member benefit contract allows for coverage of medications for weight loss in obesity/overweight; OSA coverage is gated on the obesity/overweight weight loss benefit because Zepbound treats OSA mainly through weight loss per policy rationale

Qualification pathways

You can qualify through any one of these.

Moderate to severe OSA with obesity

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age ≥ 18 years
  • Diagnosis of moderate to severe obstructive sleep apnea (AHI ≥ 15 events/hour)
  • Concurrent diagnosis of obesity (BMI ≥ 30 kg/m2)
  • Attestation medication will be used with lifestyle modification

Continuation of therapy - established on therapy prior to current health plan membership

All of:

  • Patient was established on therapy prior to current health plan membership
  • Documentation that medication was covered by another health plan
  • Clinical benefit such as disease stability
  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight

Documentation to bring

  • Clinical documentation (e.g., chart notes) confirming diagnosis of moderate to severe OSA with AHI ≥ 15 events/hour
  • Clinical documentation of concurrent diagnosis of obesity (BMI ≥ 30 kg/m2)
  • Attestation that medication will be used with lifestyle modification
  • For continuation: attestation of improvement in signs and symptoms of OSA (sleep quality, daytime functioning, or AHI from baseline)

Quantity limits

  • all strengths — 4 pens per 28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Attestation of improvement in signs and symptoms of OSA such as improvement in sleep quality, daytime functioning, or apnea-hypopnea index (AHI) from baseline. Member benefit contract coverage for weight loss in obesity/overweight re-verified at each renewal.

Not covered when

  • Central or mixed sleep apnea — considered investigational
  • Cheyne-Stokes respiration — considered investigational
  • OSA with major craniofacial abnormalities — considered investigational
  • Co-administration with other weight loss medications (Contrave, Qsymia, or other GLP-1 agents in this policy) considered investigational
  • Diabetic ketoacidosis (DKA)
  • Overweight (BMI 27-29.9) with OSA: must qualify under general Obesity/Overweight criteria (Section II.A.1) with OSA as a comorbidity, not under the OSA-specific criteria which requires BMI ≥ 30
  • Type 1 diabetes

Policy note: PAP/CPAP trial is NOT required before approval. Policy explicitly notes Zepbound treats OSA mainly through weight loss, therefore the member benefit contract weight loss coverage requirement applies. Policy note states: for overweight (BMI 27-29.9) with OSA as a comorbidity, patients should refer to the general Obesity/Overweight criteria (Section II.A.1), not the OSA-specific pathway. OSA-specific pathway requires BMI ≥ 30 (obesity) as a concurrent diagnosis.

Policy effective July 15, 2026 · verified July 16, 2026 · source: Dru787reg · View policy document (PDF)

Applies to ACA Marketplace plans.

Depends on your plan's benefit

Coverage requires that the member benefit contract allows for coverage of medications for weight loss in obesity/overweight. The policy states that Zepbound works for OSA mainly through weight loss, so the obesity/overweight benefit rider requirement applies.

Qualification pathways

You can qualify through any one of these.

Moderate-to-severe OSA with obesity

All of:

  • Member benefit contract allows coverage of medications for weight loss in obesity/overweight
  • Age ≥ 18 years
  • Diagnosis of moderate to severe obstructive sleep apnea (AHI ≥ 15 events/hour)
  • Concurrent diagnosis of obesity (BMI ≥ 30 kg/m2)
  • Attestation that medication will be used with lifestyle modification

Documentation to bring

  • Clinical documentation (such as chart notes) confirming diagnosis of moderate to severe obstructive sleep apnea with AHI ≥ 15 events/hour
  • Clinical documentation confirming concurrent diagnosis of obesity (BMI ≥ 30 kg/m2)
  • Attestation that medication will be used with lifestyle modification
  • Verification that member benefit contract allows coverage of medications for weight loss in obesity/overweight

Quantity limits

  • all strengths — 4 pens/28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Attestation of improvement in signs and symptoms of OSA such as improvement in sleep quality, daytime functioning, or apnea-hypopnea index (AHI) from baseline. Member benefit contract must continue to allow coverage for weight loss in obesity/overweight. Attestation required that medication will continue to be used with lifestyle modification.

Not covered when

  • Central or mixed sleep apnea — considered investigational
  • Cheyne-Stokes respiration — considered investigational
  • OSA with major craniofacial abnormalities — considered investigational
  • Overweight (BMI 27-29.9 kg/m2) with OSA: policy directs to obesity/overweight criteria (Section II.A.1) rather than the OSA-specific criteria which requires BMI ≥ 30
  • Co-administration with other medications for obesity or overweight (Contrave, Qsymia) is considered investigational
  • Type 1 diabetes

Policy note: OSA criteria for Zepbound were added to this policy effective 4/3/2025. PAP trial is NOT required prior to approval. The policy notes that standard of care for OSA includes PAP therapy (CPAP, APAP, BiPAP) and oral appliances, but does not require prior PAP failure. The OSA indication requires the weight loss benefit rider because the policy states Zepbound works for OSA mainly through weight loss. For overweight patients (BMI 27-29.9) with OSA as a comorbidity, coverage may be available under the general obesity/overweight criteria (Section II.A.1) rather than the OSA-specific pathway. AHI ≥ 15 events/hour defines moderate-to-severe OSA for purposes of this policy.

Policy effective March 15, 2026 · verified June 3, 2026 · source: Dru787reg · View policy document (PDF)

Open on its own page →

If weight loss isn't covered on your plan

Regence has separate Zepbound policies that don't depend on that benefit:

Questions people ask
Does Regence cover Zepbound?
It depends on your benefits. Regence covers Zepbound for weight loss only when your plan includes that benefit and the policy requirements are met.
How long does a Zepbound approval last with Regence?
Weight Loss — Applies to Employer plans. Initial approval: 12 months. Renewal: every 12 months. Weight Loss — Applies to ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months. Obstructive Sleep Apnea (OSA) — Applies to Employer plans. Initial approval: 12 months. Renewal: every 12 months. Obstructive Sleep Apnea (OSA) — Applies to ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does Regence require to renew Zepbound?
Weight Loss — Applies to Employer plans. Adults (≥18 years): ≥ 5% body weight reduction from pretreatment baseline OR dose currently being titrated upwards. Attestation required that medication continues to be used with lifestyle modification. Benefit contract coverage eligibility re-verified at each renewal. Weight Loss — Applies to ACA Marketplace plans. Adults (≥18 years): ≥ 5% body weight reduction from pretreatment baseline OR dose currently being titrated upwards. Member benefit contract must continue to allow coverage. Attestation required that medication will continue to be used with lifestyle modification. Obstructive Sleep Apnea (OSA) — Applies to Employer plans. Attestation of improvement in signs and symptoms of OSA such as improvement in sleep quality, daytime functioning, or apnea-hypopnea index (AHI) from baseline. Member benefit contract coverage for weight loss in obesity/overweight re-verified at each renewal. Obstructive Sleep Apnea (OSA) — Applies to ACA Marketplace plans. Attestation of improvement in signs and symptoms of OSA such as improvement in sleep quality, daytime functioning, or apnea-hypopnea index (AHI) from baseline. Member benefit contract must continue to allow coverage for weight loss in obesity/overweight. Attestation required that medication will continue to be used with lifestyle modification.
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 Regence: Mounjaro, Ozempic, Wegovy

Zepbound under other plans: Kaiser Permanente Northwest, Molina Healthcare, Oregon Medicaid, Premera, Washington Medicaid, Elevance Health, HCSC, Highmark

All insurance plans · All medications

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