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Does Regence cover Zepbound for Obstructive Sleep Apnea (OSA)?

It depends on your benefits. Regence covers Zepbound for obstructive sleep apnea (OSA) 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 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)

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If obstructive sleep apnea (osa) isn't covered on your plan

A prior authorization can't override a benefit exclusion. Ask Regence about a formulary exception.

Questions people ask
Does Regence cover Zepbound?
It depends on your benefits. Regence covers Zepbound for obstructive sleep apnea (OSA) only when your plan includes that benefit and the policy requirements are met.
How long does a Zepbound approval last with Regence?
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?
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.