You can qualify through any one of these.
Initial approval — Zepbound for moderate-to-severe OSA (non-preferred)
All of:
- Recent BMI >= 35 kg/m2
- Diagnosis of moderate to severe OSA confirmed within the last 2 years per most recent consensus treatment guidelines (e.g., AASM ICSD) OR baseline AHI >= 15 events/hour
- At least one clinical OSA symptom: excessive daytime sleepiness (e.g., ESS >= 10) OR reduced sleep-related quality of life (snoring, nocturnal choking, insomnia, partner sleep disruption, morning headaches, nocturia, etc.)
- Recent 6-month trial of lifestyle changes and behavioral modifications OR medical reason why immediate treatment is necessary
- Age-appropriate per FDA labeling, compendia, or peer-reviewed literature
- No contraindication to the prescribed drug
- History of therapeutic failure of, OR contraindication to, OR intolerance to the maximum FDA-approved doses of Ozempic (semaglutide), Wegovy (semaglutide), AND Mounjaro (tirzepatide)
Plus any one of:
- Utilization of PAP with documented adherence (>= 4 hours/night on 70% of nights in a consecutive 30-day period)
- PAP intolerance despite troubleshooting (mask issues, humidity, claustrophobia) AND: utilization of or intolerance to an oral appliance for OSA
Policy effective January 1, 2026 · verified June 4, 2026 · source: mab2025112403.pdf