Zepbound — Cigna

Obstructive sleep apnea, moderate to severe, in a patient with obesity

Initial criteria

Patient is ≥ 18 years of age; AND
Patient has a current BMI ≥ 30 kg/m2; AND
Patient has had a sleep study that shows BOTH of the following (a and b):
a) Patient has been diagnosed with moderate to severe obstructive sleep apnea; AND
b) Patient has an apnea-hypopnea index ≥ 15 events per hour; AND
The patient does NOT meet either of the following (a or b):
a) Central sleep apnea with percent of central apneas/hypopneas ≥ 50%; OR
b) Cheyne Stokes respiration; AND
The medication will be used concomitantly with behavioral modification and a reduced-calorie diet.

Patient is ≥ 18 years of age; AND
At baseline, patient had a BMI ≥ 30 kg/m2; AND
Patient has completed ≥ 1 year of therapy with Zepbound AND the patient meets BOTH of the following (a and b):
a) Patient has lost ≥ 10% of baseline body weight; AND
b) According to the prescriber, patient has stability in obstructive sleep apnea signs or symptoms; AND
The medication will be used concomitantly with behavioral modification and a reduced-calorie diet.

1 year