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Per Humana's pharmacy policy (effective 1/20/2025), coverage requires ALL of the following: [4] Moderate-to-severe OSA diagnosis (AHI 15 on polysomnogram or REI 15 on home sleep test) BMI 27 kg/m (lower threshold than FDA label's obesity requirement) Using Zepbound with lifestyle modifications (reduced-calorie diet + physical activity) NO diabetes diagnosis (type 1 or type 2)this is an exclusion criterion Use diagnosis code G47.33 for OSA as the primary diagnosis, with obesity as secondary

The recommendation follows extensive discussion regarding the peptides safety, effectiveness and potential clinical need

They are predictable, population-level transitions

Cunha, Ongaratto, Endres, & Barschak, 2021)

Each medication has a different purpose and dosage schedule

It is not recommended for those taking other medications