Zepbound — Point32Health
moderate-to-severe obstructive sleep apnea in adults with obesity
Initial criteria
- Patient age ≥ 18 years
- Documented diagnosis of moderate‑to‑severe obstructive sleep apnea (apnea‑hypopnea index ≥15 events/hour on sleep study)
- BMI ≥ 30
- Used as an adjunct to lifestyle modification (dietary or caloric restriction, exercise, behavioral support, community‑based program)
- Patient has been evaluated and counseled on CPAP therapy as preferred treatment OR is not a candidate for CPAP therapy (e.g., upper airway anatomic abnormalities)
Reauthorization criteria
- Positive clinical response (e.g., less daytime sleepiness, decreased respiratory events per hour)
- Currently on maintenance dose of 10 mg or 15 mg once weekly
- Used as an adjunct to lifestyle modification (dietary or caloric restriction, exercise, behavioral support, community‑based program)
- If on therapy ≤6 months: weight loss ≥5% of baseline; OR if on therapy >6 months: continuing to experience or maintain weight loss
Approval duration
6 months initial, 12 months reauth