Virginia Medicaid coverage for Zepbound (Osa)

What you need to qualify

• Diagnosed obstructive sleep apnea

Documentation to bring

• GLP-1 Receptor Agonist For Obstructive Sleep Apnea SA Form

Policy note: The document references a separate SA form titled 'GLP-1 Receptor Agonist For Obstructive Sleep Apnea SA Form'. Detailed clinical criteria are contained in the referenced fax form and not reproduced in this PDL document. Authorization length is 'as indicated on fax form'. Zepbound is listed as a Non-Preferred agent in the Weight Management Agents CLOSED CLASS section which references this OSA SA form.

Policy effective April 1, 2026 · verified June 4, 2026 · source: VAmed-PDL-List-Criteria-20260401-v6.pdf