20 Million People Could Benefit: Medicare Now Covers Zepbound for Sleep Apnea

Medicare drug plans can now cover Eli Lilly’s Zepbound for obstructive sleep apnea. This decision opens up broader access to the drug, which costs about $1,000 per month before insurance. Zepbound, approved by the FDA in December for moderate-to-severe forms of sleep apnea, affects an estimated 20 million people. Medicare Part D plans can cover obesity drugs like Zepbound if they are used for an additional medically accepted purpose. Prior authorization may be required to ensure the drug is used for the approved condition. State Medicaid coverage depends on the condition for which Zepbound is prescribed and whether Eli Lilly has signed a Medicaid drug rebate agreement. If prescribed for sleep apnea and the agreement is in place, coverage is mandatory. However, coverage for weight loss alone is not required. The Biden administration proposed a rule in November to allow Medicare and Medicaid to cover weight loss drugs for obesity, potentially costing taxpayers up to $35 billion over the next decade.

Source: www.cnbc.com