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You must meet all of these criteria: Sleep Apnea Coverage Requirements (All Must Be Met) You must be 18 or older BMI of 30 or higher Sleep study results showing moderate-to-severe sleep apnea (your sleep study score, called AHI or similar, must be greater than 15 events per hour) Sleep apnea symptoms excessive daytime sleepiness, loud snoring, choking/gasping during sleep, or trouble staying asleep Tried to lose weight before (at least one documented attempt) CPAP machine requirement you must have either: Tried CPAP (used 4+ hours/night, 70%+ of nights) but still have symptoms, OR Can't use CPAP for medical reasons No diabetes your A1C (blood sugar test) must be 6.5% or lower Sleep specialist involvement must be prescribed by or in consultation with a sleep specialist Received counseling on sleep position and avoiding alcohol/sedatives before bed No planned surgeries for sleep apnea or weight loss Must be obstructive sleep apnea only not central or mixed types To keep coverage: After 12 months, you'll need to show at least 10% weight loss and improved sleep study scores to continue on Zepbound

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