Anyone on Medicare been prescribed Zepbound for sleep apnea?

Posted by jo4joy @jo4joy, Jul 24, 2025

Has anyone with sleep apnea ever had medicare approve Zepbound for weight loss to help improve their sleep apnea?

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Profile picture for melin @melin

My doctor prescribed Zepbound for type 2 diabetes, overweight, and OSA. I was approved by my Humana part D Medicare drug plan. However, the copayment is more than the Eli Lilly Direct plan so I am getting it through them. The new cost of 2.5mg is 299 a month. It is already helping with inflammation and joint pain. After using my cpap machine for 3 years I am no longer able to tolerate it. I am not sure how it is working for the sleep apnea because I think I have to have another sleep study to actually tell.

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@melin why would Zepbound treat sleep apnea? I think if you lost weight due to the drug that would help your apnea but you didnt mention that youve lost any yet. Also why cant you use your cpap machine? Ive been using mine for about 10 years. Donyou need to try a different mask?

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Profile picture for jo4joy @jo4joy

Can you tell me the name of the powdered probiotic and fiber supplement that you take that mixes with water? I am in my fourth week of taking the Zepbound and now have found the Laxiclear and the Benefiber aren't working as well as they were in the beginning. Thank you.

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@jo4joy My doctor had me change to Metamucil 1 Tbsp per day several months ago andI have been fine since. I no longer take the Miralax and Optifiber, only the Metamucil and it is working great. I can't wait to be off the Zepbound. I am down to 129 pounds from 173 and I don't want to lose any more weight but I am afraid if I go off the Zepbound I might start to regain the weight again. I see my endocrinologist next month so I will find out what he wants me to do. I am sure Medicare will no longer cover the medicine since I am now well within normal weight.

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Profile picture for gravity3 @gravity3

@bp486

My friend is on medicare but zepbound coverage was denied. Any ideas to pass on to her? Thanks

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@gravity3
Medicare is scheduled to start a program on July1, 2026 that will pay for Zepbound with a $50 monthly co-pay.

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Just checked this out online and it is true under some conditions. Such great news.

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Profile picture for jo4joy @jo4joy

@jo4joy My doctor had me change to Metamucil 1 Tbsp per day several months ago andI have been fine since. I no longer take the Miralax and Optifiber, only the Metamucil and it is working great. I can't wait to be off the Zepbound. I am down to 129 pounds from 173 and I don't want to lose any more weight but I am afraid if I go off the Zepbound I might start to regain the weight again. I see my endocrinologist next month so I will find out what he wants me to do. I am sure Medicare will no longer cover the medicine since I am now well within normal weight.

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@jo4joy why don’t check the criteria of part D .

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The new program under Medicare will not fall under the Part D plan. It is outside that plan and you can't have underlying causes just obesity and a high BMI. The program is temporary and your doctor has to submit paperwork to get you into the program.

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Profile picture for medisecy @medisecy

@merrychristmas Zepbound has been wonderful. 11 wks and down 33 lbs. Hardly any side effects.

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@medisecy
What are the side effects?
How does Medicare or doctors determine if you're eligible? Examples: overweight by 20# pounds, BMI of 28 or more? Besides having sleep apnea. And can your primary doctor prescribe it?, or does it have to be Sleep Apnea Dr? (If there's acual doctors like that?) Does one have to have a current sleep study?, my last one may be 8-10yrs old. Thanks in advance for your answers. Congratulations on your your weight-loss

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Profile picture for bp486 @bp486

Constipation can be a problem. I put some MiraLAX in my morning coffee and have a fiber gummy in the afternoon. It seems to be manageable. My weight loss is about half a pound a week. Part of me wishes it was faster, but I have to say I don’t feel deprived of food, just eating less with better choices. My oxygen level is gradually improving. I am feeling overall better.

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@bp486 I am 67 years old and have had sleep problems since I was very young. I’ve been on numerous sleep medications that didn’t help me to fall asleep or stay asleep without having at least 2 or 3 of their listed side effects. If the medication says it can cause weight gain, I’ll be the one to gain 25 or 30 lbs. Seroquel , 100mg. Along with one 2 mg Lorazepam was working nicely for me until the weight kept piling on. Now I’m back to discussing other sleep medications with my Psychiatrist. They wouldn’t prescribe me the weight loss drugs because my BMI wasn’t over >27 or >30 but am now considered overweight. I’ve not been this heavy in over 35 +years. I’d love to be prescribed, short term, Zepbound. I truly believe in getting into a good exercise regime and continue a healthy diet, I could stay with what works (Seroquel) for sleep and use the Zepbound for the short term use to lose the weight I’ve already gained. I live in Kansas, have Medicare, BCBS FEP and thirdly, a UHC plan through Kancare.

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Profile picture for gwenrn74 @gwenrn74

Im just starting this Zepbound at $349 / month. I just started cpap and allergic to latex. Sigh. I was on Ozempic, but was severely constipated and nauseated. I thought I was fixing to throw up feces. I lost 30 lbs on O, and 30 to go on zepbound.
Monjauro is THE drug to reverse diabetes. know of two people who are not diabbetic 2 any more !! One is Michigan and one here in Colorado !!

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@gwenrn74
Were the side effects with Zepbound less/better than with Ozempic?

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