Reply to Zepbound for sleep apnea

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[quote=Anonymous]Insurance can choose what they will cover to treat sleep apnea and under what circumstances.  And can require you to exhaust less expensive options, like a mouth guard and CPAP an BiPAP first. Having an OSA diagnosis does not give you the ability to demand Zepbound as your first line of treatment.

I’m Fed BCBS and qualify for GLP-1s for obesity. But that doesn’t mean I can get Zepbound as soon as an MD signs off. Under my policy, I have to try Saxenda and Wegovy first. I have an underlying condition that makess Saxenda counter indicated. And I plateaued after a year on Wegovy and still has a BMI of 31. So, I ultimately qualified for Zepbound. But not as a first line treatment.

They will make you try and fail the more established less expensive standard of care first. And you can’t just say CPAP, BiPAP don’t work. My DH has OSA his machine monitors when it is used.  And every few months he has to do a home sleep study with it and his machine sends readings in. If the CPAP says you are noncompliant or it works, most insurances won’t let you do Zepbound instead. [/quote]

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