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For the OSA indication, separate criteria apply: Polysomnography documenting moderate-to-severe OSA (typically AHI 15+) BMI 30 or higher CPAP intolerance, insufficiency, or contraindication documentation Sleep medicine physician co-signature in some plans The December 2024 OSA pathway The FDA's December 2024 approval of tirzepatide (Zepbound) for moderate-to-severe obstructive sleep apnea in adults with obesity, based on the SURMOUNT-OSA trials (Malhotra et al., New England Journal of Medicine 2024), created a new coverage pathway
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When combined with baseline clinical assessment, these insights can support providers in deciding whether to start at standard dose, advance more carefully through titration, or adjust maintenance targets based on individual metabolic profile
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