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Key takeaways
Zepbound is the first medication that’s FDA approved to treat obstructive sleep apnea. Still, it can be difficult to get Zepbound covered by your insurance company.
Insurance companies may be more likely to cover Zepbound if you provide medical documentation of co-occurring medical conditions like diabetes, insulin resistance, or metabolic syndrome.
Sometimes, insurance companies will require step authorization for coverage, meaning that you’ve tried other, less expensive medications before your insurance company will approve Zepbound.
Zepbound, the brand name for tirzepatide, is a once-weekly injectable medication. It works as a dual GIP/GLP-1 agonist, best known for its role in weight management for people who are overweight or living with obesity. But Zepbound is also FDA approved to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity, making it the first medication that’s FDA approved to treat sleep apnea.
If you’ve been diagnosed with OSA, you may be wondering whether insurance will cover Zepbound for this condition. Coverage varies widely across insurers. Even with FDA approval, some plans require additional medical documentation showing that your sleep apnea is related to obesity or another contributing health condition. As a result, getting coverage may involve extra steps from both you and your healthcare provider.
The shifting landscape of weight loss drug coverage
The landscape of weight-loss drug coverage has shifted significantly in recent years. These medications were once viewed primarily as lifestyle treatments and were rarely covered by insurance. But as research has clarified how excess body weight contributes to conditions such as Type 2 diabetes and cardiovascular disease, many insurers have begun offering coverage for medications like Zepbound and other GLP-1 agonists, including Wegovy or Ozempic.
Despite this progress, coverage remains far from uniform. Some private insurers now include weight-loss medications in their formularies, while others continue to limit access. Meanwhile, government-sponsored plans like Medicare generally do not cover weight-loss drugs. That could change in the future, especially in light of the Trump administration’s recent agreement with pharmaceutical companies to expand Medicare coverage for GLP-1 drugs.
Because policies differ widely, it’s important to check directly with your insurance provider to understand what your specific plan covers.
Is Zepbound covered for sleep apnea?
Insurance coverage for Zepbound can be complex, even though it’s FDA-approved to treat sleep apnea in people with obesity. As Jennifer Brown, MD, a board-certified obesity medicine provider, explains, “Since Zepbound is now FDA-approved for the treatment of obesity-related obstructive sleep apnea (OSA), many insurance plans cover it specifically for this indication.” Still, as she notes, “coverage varies by insurance plan.”
Some patients may have an easier time getting coverage by using a different brand of the same medication. Tirzepatide, the active ingredient in Zepbound, is also available as Mounjaro. “In my experience, most insurance plans cover tirzepatide (under the name Mounjaro) for the treatment of Type 2 diabetes,” Dr. Brown shares. “For patients who have both Type 2 diabetes and OSA, it’s easier to get coverage by prescribing Mounjaro instead of Zepbound.”
Coverage decisions may also depend on your overall health profile. “Coverage is more likely when co-morbidities exist,” says Nadia K Sirdar, MD, an internal medicine doctor at Bethesda Modern Primary Care. Insurers may be more inclined to approve Zepbound for OSA if you have a body mass index (BMI) over 30 or between 27 and 30 with a weight-related condition, like metabolic syndrome, insulin resistance, or diabetes, according to Dr. Sirdar. Approval may also be more likely if your sleep apnea is causing symptoms that make lifestyle changes harder, such as “daytime sleepiness and fatigue making lifestyle interventions like increased physical activity or exercise exponentially more difficult,” she adds.
In some cases, demonstrating that standard treatments haven’t worked can further support coverage. CPAP and other positive airway pressure therapies are considered first-line treatments, but not everyone can tolerate them. “OSA is treated with PAP (positive airway pressure), but many people do not tolerate this,” Dr. Sirdar explains. “It requires the person to wear a mask all night that ‘pushes’ air in, and often people will take it off after a few hours or not wear it consistently every night.”
When your healthcare provider documents these symptoms, challenges, or co-morbidities, insurers may be more likely to approve Zepbound, according to Dr. Sirdar.
How to get Zepbound covered for sleep apnea
Getting insurance approval for Zepbound can be challenging, but there are several strategies you and your healthcare team can use to improve your chances for eligibility. Two of the most common approaches are step therapy and prior authorization.
Step therapy
If your insurance company won’t initially cover Zepbound, “step therapy is an option,” Dr. Sirdar says. This process requires trying a similar, often less expensive, medication first and documenting that it isn’t effective or causes problematic side effects. For Zepbound, step therapy may involve “trying Wegovy first, and if you’re not able to tolerate it after, say, three months, then switching to Zepbound,” Dr. Sirdar explains. Other plans may require a non-GLP-1 drug for weight loss first. Demonstrating that you’ve already attempted an alternative can sometimes open the door to Zepbound approval.
Prior authorization
Prior authorization is another key tool in securing coverage. It requires your healthcare provider to submit detailed documentation explaining why Zepbound is medically necessary for you. “Prior authorization is almost always required when I prescribe Zepbound for OSA,” Dr. Brown says. According to Dr. Brown, insurers typically want to see “documentation of a BMI over 30, a sleep study performed within the past six months, and a diagnosis of moderate or severe OSA based on the sleep study results.”
Working closely with your provider to ensure all required information is included can make prior authorization more successful.
What to do if your health insurance doesn’t cover Zepbound
If you are having trouble getting your insurance company to cover Zepbound for sleep apnea, you aren’t alone. Not only that, but a “no” from your insurance company doesn’t mean there isn’t hope. Here are some options for getting your Zepbound prescription at a rate you can afford.
Use a SingleCare coupon
Using a SingleCare savings card can cut out-of-pocket costs significantly from the retail price. Using SingleCare coupons is easy. Simply print, text, or email your Zepbound coupon and show it to your pharmacist when you pick up your Zepbound prescription. SingleCare coupons are free for you to use, with no strings attached.
Save up to 80% on Zepbound with SingleCare
Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.
File an appeal
When an insurance company denies your request for prescription medication coverage, you can file an appeal. You have a legal right to appeal a decision your insurance company has made. Often, this appeal will come in the form of a letter you write to them explaining why you believe the insurance company made the incorrect decision about your medication coverage. You can also include documentation from your healthcare provider explaining why this prescription drug is a medical necessity for you.
Consider alternative treatments
Zepbound isn’t the only effective treatment for sleep apnea. Here are some other treatments to consider.
Alternative medications
If your health insurance doesn’t cover injectable medications like Zepbound, you may be able to try other medications. Because there’s no other approved option for sleep apnea, you can try another weight-loss medication that may have benefits for sleep apnea.
Dr. Sirdar recommends talking to your provider about the following medications as treatment options:
- Qsymia (phentarmine-topiramate)
- Contrave (naltrexone-bupropion)
- Xenical (orlistat)
- Lomaira (phentermine)
- Saxenda (liraglutide)
According to Dr. Sirdar, these medications are best for people with a BMI over 30 or elevated central (abdominal) obesity, along with OSA. Keep in mind that some of these may be required as step therapy before Zepbound can be approved anyway. Certain oral drugs like Rybelsus (semaglutide) and metformin are for diabetes but might be prescribed off-label for weight loss.
CPAP therapy
Besides medication, “OSA is also treated with continuous positive airway pressure (CPAP) therapy, which has been the gold standard treatment until Zepbound was approved for OSA,” Dr. Brown says. If you haven’t tried CPAP therapy already, you can discuss this with your provider as a treatment for your sleep apnea.
- Label: Zepbound- tirzepatide injection, solution, DailyMed (2025)
- FDA approves first medication for obstructive sleep apnea, U.S. Food and Drug Administration (2024)
- Shifting paradigms: Reframing coverage of antiobesity medications for plan sponsors, Journal of Managed Care and Specialty Pharmacy (2023)
- Trump administration says lower prices for 15 Medicare drugs will save taxpayers billions, Associated Press (2025)
- Appealing a health plan decision, Healthcare.gov