You can qualify through any one of these.
Initial Authorization – Zepbound for OSA
All of:
- Treatment requested for obstructive sleep apnea
- Patient is 18 years of age or older
- BMI >= 30 kg/m2 documented in medical records
- Moderate-to-severe OSA evidenced by sleep study AND (AHI > 15 events/hour OR REI > 15 events/hour OR RDI > 15 events/hour)
- At least one previous unsuccessful dietary effort to lose weight documented
- Used in combination with a reduced calorie diet and increased physical activity
- No diagnosis of diabetes AND HbA1c <= 6.5%
- Provider attests patient counseled on appropriate positional therapy
- Provider attests patient counseled on avoidance of alcohol and/or sedatives before bedtime
- Prescriber attests no planned surgery for sleep apnea or obesity
- Prescriber attests no diagnosis of predominant central or mixed sleep apnea (mixed/central apneas/hypopneas > 50% of all respiratory events)
- Prescribed by or in consultation with a sleep specialist
Plus any one of:
- Patient has continued symptoms of OSA despite PAP therapy adherence (>= 4 hours/night for >= 70% of nights)
- Patient is not a candidate for PAP therapy (e.g., upper airway anatomic abnormalities)
Reauthorization – On therapy < 52 weeks
All of:
- Patient has been on Zepbound for less than 52 weeks of consecutive therapy
- Medical records confirm any decrease from baseline in AHI, RDI, or REI after initiating Zepbound
- Weight loss >= 10% of baseline body weight
- Used in combination with a reduced calorie diet and increased physical activity
- No diagnosis of diabetes AND HbA1c <= 6.5%
- Patient continues to require treatment for obstructive sleep apnea
Reauthorization – On therapy >= 52 weeks
All of:
- Patient has been on Zepbound for >= 52 weeks of consecutive therapy
- Medical records confirm >= 50% decrease from baseline in AHI, RDI, or REI after initiating Zepbound
- Weight loss >= 10% of baseline body weight
- Used in combination with a reduced calorie diet and increased physical activity
- No diagnosis of diabetes AND HbA1c <= 6.5%
- Patient continues to require treatment for obstructive sleep apnea
Policy effective March 1, 2026 · verified June 2, 2026 · source: PA-Non-Formulary-Zepbound.pdf