Zepbound — United Healthcare
moderate to severe obstructive sleep apnea
Initial criteria
- Treatment is being requested for appetite suppression or weight loss OR Wegovy is being requested for risk reduction of major adverse cardiovascular events with established cardiovascular disease (i.e. prior myocardial infarction, ischemic or hemorrhagic stroke, or peripheral arterial disease) OR Zepbound is being requested for moderate to severe obstructive sleep apnea
- AND Patient is ≥ 12 years of age for Wegovy OR Patient is > 16 years of age for Zepbound
- AND Used as an adjunct to lifestyle modification (e.g., dietary or caloric restriction, exercise, behavioral support, community-based program)
- AND Body Mass Index (BMI) ≥ 40 kg/m2 or for pediatric patients a BMI > 120% of 95th percentile
Reauthorization criteria
- Weight loss of ≥ 5% of baseline body weight
- AND Continuation of lifestyle modification
Approval duration
Initial: Wegovy 5 months; Zepbound 6 months. Reauth: 12 months.