Yes, when the prescription is for sleep apnea. Medicare Part D cannot cover a drug for weight alone [3]. Sleep apnea with obesity is a different use. A Medicare claims study lists it among the uses Medicare currently covers [2]. The label use is moderate to severe apnea in adults with obesity. Its trials required 15 or more breathing events an hour on a sleep study [5].
The weight exclusion is old: Part D was built with weight-loss drugs explicitly excluded [3]. That rule still applies today. The broader Medicare picture is in whether Medicare covers Ozempic and Wegovy. This page covers one route through it.
Why sleep apnea is a different claim
A claim is judged by its use, not its molecule. Zepbound has two uses on its label. One is weight reduction, and the other is moderate to severe obstructive sleep apnea in adults with obesity [5]. The second is not a weight-loss use.
A 2026 study used every Medicare fee-for-service claim for 2023 and 2024 [2]. It listed four covered GLP-1 uses [2]. Two are type 2 diabetes and heart disease with overweight or obesity. The others are sleep apnea with obesity and a fatty liver disease [2]. Obesity alone was not on the list. About 1.2 million beneficiaries had only obesity and were ineligible [2].
The molecule is the same one sold as Mounjaro. The label is what differs, as whether Zepbound is the same as Mounjaro explains.
The diagnosis has to be on paper
The label’s trials defined moderate to severe apnea by a number. They required an apnea-hypopnea index of 15 or more events an hour [5]. That was measured by polysomnogram, an overnight sleep study [5]. The trials also required a BMI of 30 or more [5]. People with type 2 diabetes were excluded [5].
The index itself depends on a scoring rule. A hypopnea can be counted at a 4% drop in oxygen, or at a 3% drop or an arousal [4]. One study rescored a sample of 2,057 people both ways [4]. Under the stricter 4% rule, 60% moved to a milder grade or lost the diagnosis [4].
That shift reached drug eligibility. Of those who looked eligible for tirzepatide under the 3% rule, 35% were not under the 4% rule [4]. That was 180 people. Women were reclassified more often than men [4]. The sleep report is therefore the document to read first.
What the trials measured
SURMOUNT-OSA was two 52-week trials [1]. One enrolled people not using CPAP, and the other enrolled people already on it. Starting indexes averaged 51.5 and 49.5 events an hour [1].
Without CPAP, the index fell 25.3 events an hour on tirzepatide and 5.3 on placebo [1]. With CPAP, it fell 29.3 against 5.5 [1]. Doses were 10 mg or 15 mg, the maximum each person tolerated [1]. The full trial read is in whether GLP-1 drugs help sleep apnea.
Eligible is not the same as filled
Among 16,474,786 Medicare fee-for-service beneficiaries with Part D, 35.1% had a covered GLP-1 condition [2]. Of those, 16.5% had a claim [2]. The authors say eligibility alone may not become treatment without addressing affordability [2].
That figure covers fee-for-service only. Medicare Advantage enrollees are not in it [2]. Follow-up after starting is another gap. Few sleep centers adjust CPAP on their own initiative once weight falls, as the CPAP review survey found.
What it costs without coverage
The sleep apnea doses are 10 mg or 15 mg a week [5]. Lilly’s list price is “$499 - $1,086.37 per fill” [6]. That is its wholesale figure, not a counter price [6].
Lilly’s own pharmacy prints a lower cash figure. At 10 mg and 15 mg it reads “Starting at $449/month” “when you refill within 45 days” [7]. Miss that window and the footnote applies: “$699 for 10mg” and “$699 for 15mg” [7]. A month is 28 days and one KwikPen [7].
Lilly’s $25 savings card is not an option on Medicare. Its terms read “Governmental beneficiaries excluded” [6]. Cash prices across the market are in what a GLP-1 costs per month. Compounded tirzepatide is not FDA-approved and carries no sleep apnea use.