Does Medicare cover Zepbound for sleep apnea?

In 2024, the US Food and Drug Administration (FDA) approved Zepbound for obstructive sleep apnea (OSA), making it the first medication approved to treat the common sleep disorder. Out of pocket, Zepbound costs anywhere from $299 to over $1,000 per month. But people with Medicare may be able to pay much less. Read on to learn more.

Yes, Medicare covers Zepbound for sleep apnea when it’s prescribed to treat moderate to severe obstructive sleep apnea (OSA). 

Previously, when Zepbound was only approved for weight loss, Medicare could not cover the drug because Medicare plans do not cover anti-obesity medications. 

Which Medicare plans cover Zepbound for sleep apnea?

Zepbound is covered by Medicare plans that include Medicare Part D coverage. 

Medicare Part D covers brand-name and generic drugs. Medicare Part D is available as a standalone prescription drug plan as well as through a Medicare Advantage (Part C) plan, which usually has Part D drug coverage bundled in.

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See if you qualify

To get Medicare to cover Zepbound for sleep apnea, you’ll need to enroll in a Medicare Part D plan, have both sleep apnea and obesity, and your provider may need to complete a prior authorization. 

Here’s a step-by-step breakdown of how to get Medicare to cover Zepbound for sleep apnea:

1. Have (or enroll) in a Medicare Part D plan. Medicare Part D is available for people who have Original Medicare (Part A and B) and Medicare Advantage (Part C) plans. If you don’t currently have a Medicare Part D plan, you’ll need to enroll before you can get coverage for Zepbound.

2. Receive a sleep apnea diagnosis. Medicare only covers Zepbound when it’s prescribed for sleep apnea. If you don’t already have a sleep apnea diagnosis, you’ll need to schedule an overnight sleep study in a lab (called a polysomnogram) or take an at-home sleep apnea test (HSAT).

3. Have obesity or a body mass index (BMI) of 30 or above. Zepbound is only approved to treat sleep apnea in adults with obesity, which is defined as having a BMI of 30 or higher. Your BMI is calculated using your height and weight. (You can check yours with our online BMI calculator. But your healthcare provider may assess yours before writing a prescription for Zepbound.)

4. Get a prescription for Zepbound for sleep apnea. Zepbound is only available with a prescription from a licensed healthcare provider. So you’ll need to meet with one either online, such as through Ro, or in person, such as by meeting with your primary care provider or a sleep medicine specialist. It’s important that your prescription is specifically for sleep apnea — not for weight loss — as Medicare will only cover Zepbound for OSA.

5. Submit prior authorization. Prior authorization is a form that your healthcare provider will submit on your behalf to Medicare, requesting that your plan cover Zepbound. Medicare plans often require prior authorization before covering more expensive GLP-1 drugs like Zepbound. It’s possible your plan may require step therapy as well, showing that you’ve already tried other methods to treat your sleep apnea.

Currently, the cost of Zepbound with Medicare depends on your specific plan. There are many different Medicare Part D and Medicare Advantage plans available, each with its own coverage rules. But that will be changing soon for Zepbound.

In 2026, the maximum deductible for Medicare plans is $615, and the maximum out-of-pocket cost for covered medications under Medicare Part D is capped at $2,100.

Starting in April 2026, Zepbound will have a copay of $50 per month with Medicare, according to a new agreement between Eli Lilly, the drug manufacturer, and the US government. 

You can check if your Medicare plan covers Zepbound for sleep apnea by: 

1. Contacting Medicare directly. You can contact Medicare by phone at 1-800-MEDICARE (1-800-633-4227) or online using their Live Chat. 

2. Reviewing the drug formulary. This is a list of all the drugs covered by your plan. You can find your plan's drug formulary at Medicare.gov.

3. Using Ro’s GLP-1 Insurance Coverage Checker. With Ro’s free online tool, you can check if your insurance plan covers Zepbound (and see where Zepbound is available in your area).

If your Medicare plan doesn’t cover Zepbound for sleep apnea, there are still other ways you can get the medication without having to pay full price.

1. Pay cash for Zepbound

One way to get Zepbound for less is to pay cash (or “self-pay”) through Ro. With this self-pay option, you can get the Zepbound vials for the following cash prices: 

• $299 per month for the 2.5 mg dose

• $399 per month for the 5 mg dose 

• $499 per month for the 7.5 mg, 10 mg, 12.5 mg, and 15 mg doses with a manufacturer offer 

2. Compare prices at multiple pharmacies

Pharmacies can set their own retail price for a medication, so it can be worth it to consider other options than your go-to pharmacy. Call around to other local pharmacies in your area or consider telehealth programs such as Ro. Telehealth programs may even ship Zepbound free to your home (Ro does!). 

3. Use pharmacy discount cards

If you do fill your Zepbound prescription through a pharmacy (as opposed to using the self-pay option), you can still save using a pharmacy discount card. 

These pharmacy-specific Zepbound coupons are free to download and use. You’ll just need to visit one of the sites below, and find the coupon for your preferred pharmacy and Zepbound dosage.

• SingleCare

• GoodRx

• Optum Perks

• Drugs.com

• WellRx

• BuzzRx

See if you qualify

The relatively recent FDA approval of Zepbound for sleep apnea offers a new coverage option for people on Medicare who want affordable access to the GLP-1 medication. Here’s what to remember if you’re hoping your Medicare plan will cover the medication.

• Medicare only covers Zepbound when it’s prescribed for moderate-to-severe obstructive sleep apnea (OSA), not weight loss.

• To access this benefit, you must be enrolled in a Medicare Part D plan, which can be a standalone plan or bundled with Medicare Advantage.

• Your healthcare provider will likely need to submit prior authorization confirming that you meet eligibility criteria, such as a confirmed diagnosis of both sleep apnea and obesity.

• Starting in April 2026, a new agreement caps the Medicare copay for Zepbound at $50 per month.

• If your plan doesn’t cover Zepbound, you can still save on Zepbound by paying cash, price-shopping different pharmacies, and using pharmacy discounts.