Wyoming Medicaid coverage for Zepbound (Osa)

What you need to qualify

• Age 18 and older
• Diagnosed obstructive sleep apnea (AHI of 15 or higher)

Qualification pathways

You can qualify through any one of these.

Documentation to bring

• Documentation of diagnosis of moderate to severe obstructive sleep apnea
• Sleep study performed within the prior 12 months showing AHI > 15
• Documentation that patient is an obese adult
• At 6-month renewal: documentation of at least 5% weight loss
• At 12-month renewal: documentation of improvement in obstructive sleep apnea

Approval and renewal

• Initial approval: 6 months
• Renewal: every 6 months
• To renew, the plan looks for at least 5% weight loss from the starting weight and At 6-month renewal: at least 5% weight loss required. At 12-month renewal: demonstrated improvement in obstructive sleep apnea required. Make sure your starting weight and date are in the chart now — renewal is measured against it.

Policy note: Zepbound is listed as a preferred GLP-1 agonist under the Obstructive Sleep Apnea therapeutic class on the Wyoming Medicaid PDL effective April 15, 2026. The policy requires a two-stage continuation review: re-authorization at 6 months requires at least 5% weight loss; re-authorization at 12 months requires demonstrated improvement in OSA. The policy states 'obese adults,' which implies an obesity requirement, but no explicit BMI threshold is stated. AHI > 15 is required (consistent with moderate-to-severe OSA). No PAP/CPAP trial is required per this document. The document does not address Zepbound for weight_loss indication, so no entry is emitted for that indication.

Policy effective April 15, 2026 · verified June 4, 2026 · source: pdl-2026-041526.pdf