Medicare can now cover Eli Lilly's Zepbound for sleep apnea, CMS says

Medicare and Medicaid Coverage for Zepbound - Medicare Part D plans can now cover Eli Lilly's Zepbound for obstructive sleep apnea (OSA), expanding access to the drug which was previously not covered for weight loss [1][2] - Medicare Part D coverage for obesity drugs like Zepbound requires FDA approval for an additional medically accepted purpose, and prior authorization may be used to ensure proper usage [3] - State Medicaid programs must cover Zepbound if prescribed for OSA and Eli Lilly has signed the Medicaid drug rebate agreement, but coverage is not required if prescribed for weight loss [7][8] FDA Approval and Market Impact - Zepbound was approved by the FDA on Dec 20 for obesity and moderate-to-severe OSA, making it the first drug treatment for an estimated 20 million people with these conditions [4] - Demand for Zepbound has soared over the past year despite its $1,000 price tag before insurance [1] Comparative Coverage and Industry Trends - Medicare Part D plans also cover Novo Nordisk's Wegovy for its approved use of lowering cardiovascular risks, while diabetes counterparts Ozempic and Mounjaro are covered by Medicare and most insurance plans [5] - Both Eli Lilly and Novo Nordisk are studying their weight loss drugs for additional conditions like fatty liver disease, chronic kidney disease, and sleep apnea, which would require late-stage trial results and FDA approval for coverage [6] Policy and Cost Implications - The Biden administration proposed a rule in November to allow Medicare and Medicaid coverage for weight loss drugs, potentially giving millions access to weekly injectables but costing taxpayers up to $35 billion over the next decade [9]