Zepbound for sleep apnea: Insurance coverage updates
This was last updated on 3/10/25 and I’ll periodically refresh it as we learn more.
Obstructive sleep apnea (OSA) has long been treated with machines (like CPAP) or lifestyle changes, but now there’s a new option in the mix – Zepbound for sleep apnea.
In this post, we’ll explore what Zepbound is, how it works for sleep apnea, the key research behind its approval, and important questions about Medicare and insurance coverage.
Fun fact: Zepbound contains the same active ingredient called “tirzepatide” as the diabetes drug Mounjaro, which has been on the market for years. However, it’s marketed specifically for weight management and now sleep apnea.
What We’re Going to Cover
What Is Zepbound and How Does It Help with Sleep Apnea? – A look at how this medication works and why weight loss can improve OSA symptoms.
Is Zepbound Approved for Sleep Apnea? – Details on the FDA approval, the SURMOUNT clinical trial results, and Eli Lilly’s role in this landmark study.
Does Medicare Cover Zepbound for Sleep Apnea? – An up-to-date explanation of Medicare’s rules and whether Part D plans will pay for Zepbound.
Will Insurance Cover Zepbound for Sleep Apnea? – What to know about private insurance coverage, costs, and steps to find out if your plan covers Zepbound.
Have Questions?
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What Is Zepbound and How Does It Help with Sleep Apnea?
Zepbound is a prescription medication originally developed for weight loss, and in late 2024 it became the first drug ever approved by the FDA to treat moderate-to-severe sleep apnea in adults with obesity (Malhotra, 2024). This is big news for my patients with OSA, as Zepbound addresses a root cause of the condition (excess weight) by helping people lose weight, which in turn can improve their breathing at night.
It’s given as a weekly injection designed to help people lose weight. It works by activating certain gut hormone receptors (GLP-1 and GIP), which atually slow down digestion and curb your appetite, making you feel full sooner and less hungry (Hudgel, 2018). By eating less and losing weight, patients address one of the main factors that worsens sleep apnea. In fact, successful weight loss is key to managing most OSA cases, which is why doctors like me prescribe Zepbound as part of a sleep apnea treatment plan (US FDA, 2024). Essentially, Zepbound helps people shed pounds, and losing excess weight often leads to fewer apnea events and better sleep (Greer, 2020).
It’s worth noting that Zepbound’s active ingredient, tirzepatide, was first used in the diabetes drug Mounjaro. Both Zepbound and Mounjaro contain tirzepatide (Greer, 2013), but they are marketed for different purposes. Mounjaro is for type 2 diabetes, whereas Zepbound is focused on chronic weight management and obesity-related conditions such as sleep apnea. By helping patients achieve significant weight loss, Zepbound can indirectly improve or even sometimes resolve OSA symptoms that are linked to obesity.
Is Zepbound Approved for Sleep Apnea?
Yes! It is!
Zepbound received FDA approval in December 2024 specifically for treating obstructive sleep apnea in adults with obesity (Malhotra, 2024). This made it the first medication ever approved to treat OSA – a landmark moment, since previously the treatments for OSA were devices (like CPAP) or surgeries rather than drugs. The approval was backed by compelling clinical research. In particular, Eli Lilly (the manufacturer of Zepbound) sponsored a major trial known as SURMOUNT-OSA (Malhotra, 2024).
Does Medicare Cover Zepbound for Sleep Apnea?
Historically, Medicare did not cover Zepbound or any similar weight loss medications when they were approved only for obesity (AARP, 2024). However, the situation changed once Zepbound gained approval for sleep apnea. Medicare can cover a drug if it’s approved for a medical condition beyond just weight loss. In early 2025, the Centers for Medicare & Medicaid Services (CMS) confirmed that Medicare Part D plans are now allowed to cover Zepbound for the treatment of obstructive sleep apnea (AARP, 2024).
Will Insurance Cover Zepbound for Sleep Apnea?
Beyond Medicare, what about other insurance? Coverage in the private insurance world is a bit of a patchwork. Many private insurers have been hesitant to cover expensive weight loss drugs like Zepbound (Hudgel, 2018). However, with the FDA approval for sleep apnea (which is a serious and can even be life threatening medical condition), we’re starting to see a shift. Insurers often reconsider coverage when a drug is indicated for a medical illness rather than just cosmetic or lifestyle purposes.
That said, coverage varies widely by insurer and plan. There’s no universal rule among private insurance — each company decides if Zepbound is on their “formulary” (US FDA, 2024). If you’re wondering whether your insurance will cover Zepbound, the best approach is to check your plan’s drug formulary or call your insurance provider directly. And depending on the case, a good doctor (which we like to think we are) will at least try and convince your insurer it’s the right thing when it makes sense.
Conclusion
Zepbound for sleep apnea represents a promising new avenue for treating OSA by tackling it at its source – excess weight. It’s an FDA-approved medication that has shown impressive results in reducing sleep apnea episodes and helping patients lose weight at the same time (Malhotra, 2024). Thanks to the landmark SURMOUNT trial we have solid evidence that weight loss via Zepbound can significantly improve or even resolve obstructive sleep apnea in many cases (Greer, 2020).
Want to take action?
An at-home sleep test is one of the easiest and most effective ways to check if you have sleep apnea. We’re a sleep telemedicine clinic so everything can be done from the comfort of your home.
References
Malhotra A, White DP, Strollo PJ, et al. Tirzepatide for the Treatment of Obstructive Sleep Apnea. N Engl J Med. 2024;390(1):23-35.
Hudgel DW, Randerath W, Verbraecken J, et al. Weight Reduction in Sleep Apnea: Effects on Apnea Severity and Cardiovascular Outcomes. Chest. 2018;153(1):225-232.
Greer SM, Goldstein AN, Walker MP. The Impact of Sleep Loss on Food Desire in the Human Brain. Nat Commun. 2013;4(1):2259.
Greer SM, Walker MP. Sleep Deprivation and Its Impact on Appetite Regulation and Obesity Risk. J Clin Endocrinol Metab. 2020;105(1):670-676.
US Food and Drug Administration. Zepbound (tirzepatide) Prescribing Information. Silver Spring, MD: FDA; 2024.
AARP. Medicare Changes Coming in 2025. 2024. Available from: https://www.aarp.org/health/medicare-insurance/info-2024/medicare-changes-coming-in-2025.html.