The Food and Drug Administration (FDA) approved Zepbound in December 2024 for treating obstructive sleep apnea (OSA). Medicare Part D may cover Zepbound, but only when a doctor prescribes it for OSA.

As of November 2023, the Food and Drug Administration (FDA) approved Zepbound for chronic weight management in adults.

Due to current legislation regarding weight loss drugs, it is not yet available to Medicare recipients.

But in November 2024, the Centers for Medicare & Medicaid Services (CMS) proposed reinterpreting the exclusion of weight loss medications to help with obesity starting in 2026.

The active ingredient in Zepbound is tirzepatide, the same active ingredient in Mounjaro. Mounjaro is already FDA-approved to treat type 2 diabetes, and some Medicare Part D plans may cover the costs of both drugs when a doctor prescribes them for reasons other than weight loss.

Medicare may cover Zepbound for people with moderate to severe obstructive sleep apnea (OSA). Zepbound became the first OSA drug to receive FDA approval.

Coverage would fall under Medicare Part D prescription drug plans or Medicare Advantage (Part C) plans that include prescription drug coverage. Out-of-pocket costs may also apply.

OSA happens when your upper airway becomes blocked and causes interruptions to your breathing while you sleep.

Anyone can develop OSA, but it is more commonly seen in people with obesity or a higher body mass index (BMI).

Zepbound works by activating glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). These are hormone receptors that the intestine produces.

When these hormones are activated, they slow stomach emptying and reduce glucagon secretion. Glucagon is a hormone involved in appetite and blood sugar regulation. This could help you to lose excess weight.

Successful weight loss is key to managing OSA, which is why doctors and healthcare professionals may prescribe Zepbound as part of your OSA treatment plan.

Zepbound’s combined effects on GLP-1 and GIP may be more effective than other GLP-1 agonists, like Wegovy or Ozempic. This is because Zepbound affects both GLP-1 and GIP.

It is best to check your Medicare Part D plan’s formulary (drug list) to confirm coverage.

Currently, Medicare Part D covers these medications only for other FDA-approved conditions, such as type 2 diabetes or cardiovascular disease. But this could soon change.

In November 2024, the CMS proposed reinterpreting the rules regarding weight loss medications. This would mean that Medicare would cover antiobesity medications. The proposed changes would take effect in 2026.

Zepbound is a prescription-only weight loss drug manufactured by Eli Lilly. People prescribed this medication inject themselves with weekly doses.

According to the FDA, to be eligible for Zepbound, you must have a BMI of 30 or higher or a BMI of 27 or higher and at least one weight-related condition, including:

Doctors typically prescribe Zepbound alongside lifestyle adjustments, such as following a specific meal plan and exercise regimen.

Medicare Part D prescription drug plans may cover Zepbound if a doctor prescribes it for an eligible medical condition, like OSA.

You can check your Part D plan documentation or contact your insurer directly to confirm coverage and avoid unexpected out-of-pocket costs.