Coverage of Zepbound for obstructive sleep apnea ending

Starting August 1, 2025, or upon 2025 plan renewal, we will remove coverage from the Select/Value formularies of Zepbound^® (tirzepatide) for the treatment of obstructive sleep apnea (OSA) for members with a current prescription. This change was effective May 1, 2025, for new prescription starts.

Why we’re making this change

Zepbound’s benefits are limited to weight loss, and at this time there are no clinical studies to support that the drug treats OSA through any other mechanism. This update aligns with our exclusion of coverage for weight loss drugs.

What this means for affected members

Impacted members will be notified by mail of this change by June 1.

Members who choose to continue taking Zepbound for the treatment of OSA after August 1, or upon 2025 plan renewal, will be responsible for the full cost of the drug. Zepbound may be Health Savings Account (HSA) eligible.

We cover other treatment options for OSA, such as a continuous positive airway pressure (CPAP) machine, bi-level positive airway pressure machine (BIPAP), special mouthpiece devices, and nerve stimulators when criteria are met. Surgical treatment may be an option for some members. Members should check their benefits to see what is covered for OSA.

Supporting our customers and their members

Our mission is to improve health and well-being in the communities we serve. We prioritize supporting members’ health and keeping healthcare affordable for everyone.