Loading...Loading...August 26, 2025
We want to inform you of an important update regarding coverage for Zepbound (tirzepatide) for obstructive sleep apnea (OSA) treatment that may impact your employees.
Effective immediately, Zepbound will not be covered for OSA treatment unless a group has weight loss drug coverage and the member meets specific clinical criteria.
Medicare is currently prohibited by law from covering medications used specifically for obesity. However, members may obtain coverage for a GLP-1 agonist that has an FDA-approved indication other than obesity, like diabetes or cardiovascular disease.
- Zepbound (tirzepatide), Eli Lilly's GLP-1 agonist, received FDA approval in December 2024 for treating moderate to severe obstructive sleep apnea.
- While effective for sleep apnea symptoms, Zepbound primarily works through its weight loss mechanism.
- All GLP-1s indicated for treating an obesity diagnosis (such as Wegovy, Saxenda and Zepbound) continue to be excluded from coverage, except for groups that have opted to cover the drugs for obesity and overweight.
- All GLP-1 agonists require pre-authorization.
For complete details on coverage criteria and policy specifics, please refer to the updated GLP-1 agonists policy for non-diabetes indications: GLP-1 Agonist-Containing Medications for Non-Diabetes Indications