Will Insurance Cover Ozempic for Sleep Apnea?

Glucagon-like peptide-1 receptor agonists (GLP-1s) like Ozempic can help with weight loss, which may assist with sleep apnea symptoms. If your sleep apnea has worsened with weight gain or you have other medical conditions that warrant the use of GLP-1s, your healthcare provider may prescribe one, Trusted Source National Association of Insurance CommissionersView Source but they can be pricey. Monthly out of pocket costs often reach several hundred dollars, and some plans require you to try CPAP or a weight-loss program before approving the medication.

So, will insurance cover Ozempic for sleep apnea? The short answer is no, but some insurance plans may cover other GLP-1s for sleep apnea, especially if you also have other health conditions like high blood pressure or diabetes.

Even if your insurance won’t cover a GLP-1, you still have options. Your provider can document medical necessity, which strengthens insurance approval attempts for weight loss medications. Below, learn how weight loss drugs may improve sleep apnea, how to check your insurance coverage, and what other options exist.

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How Does Ozempic Work for Sleep Apnea?

Obstructive sleep apnea (OSA) happens when your airway gets blocked during sleep, causing a pause in breathing. These episodes can happen many times throughout the night and last anywhere from 10 to 30 seconds.

Carrying extra weight around the neck is a major risk factor for OSA, as excess tissue can crowd your airway while you sleep Trusted Source MSD ManualsFirst published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers.View Source . About 31% of people with obstructive sleep apnea have obesity while 44% are overweight Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source . Because of this connection, experts have started researching to see if GLP-1s like Ozempic can also improve symptoms of OSA Trusted Source Journal of Translational MedicineView Source . 

A clear relationship exists between weight loss and better sleep apnea outcomes. A study review found that a 20% decrease in BMI led to a 57% reduction in sleep apnea symptoms Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source .

Other research confirms GLP-1s may improve sleep apnea symptoms through weight loss, a lower BMI (body mass index), and a smaller waist size. But not all GLP-1s offer the same benefits. For example, another study review found that tirzepatide (Zepbound) improved OSA symptoms more than liraglutide (Saxenda). Trials also show that tirzepatide improves daytime sleepiness and blood pressure, two issues that often accompany sleep apnea.

Is Ozempic Approved for Sleep Apnea?

Currently, the U.S. Food and Drug Administration (FDA) has not approved Ozempic to treat sleep apnea or weight loss. Ozempic is only approved by the FDA to treat type 2 diabetes. The only FDA-approved GLP-1s for weight loss are semaglutide (Wegovy), liraglutide (Saxenda), and tirzepatide (Zepbound). 

Among these, only Zepbound has FDA approval for sleep apnea. In 2024, the FDA approved Zepbound for the treatment of moderate to severe OSA in adults with obesity Trusted Source U.S. Food and Drug Administration (FDA)The FDA is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation's food supply, cosmetics, and products that emit radiation.View Source . This approval was based on a large clinical trial showing significant reductions in apnea-hypopnea index (AHI) or sleep apnea severity after weight loss.

Will Insurance Cover Ozempic for Sleep Apnea?

Insurance typically won’t cover Ozempic for sleep apnea since the FDA hasn’t approved its use for that condition.  Sometimes, providers will prescribe medications “off-label,” meaning they offer them because they may help with a condition not listed in the approved indications. But insurers typically won’t cover a drug for off-label use. 

However, if you have another health condition alongside OSA, you may still be eligible for GLP-1 coverage. For example, Ozempic is FDA-approved for type 2 diabetes, so if you have this condition, your insurance may pay for it. Weight loss and improved sleep apnea become added benefits. Trusted Source National Association of Insurance CommissionersView Source .

Some insurance plans also cover GLP-1s for obesity-related health conditions like high cholesterol or high blood pressure, but each company sets its own criteria. If you have one of these health conditions plus a high BMI and obstructive sleep apnea, you may get insurance coverage for GLP-1s.

Now that Zepbound has been approved to treat OSA, more insurers may cover this medication. Many payers are adding Zepbound to formularies, although prior authorization is common. Requirements often include a BMI threshold, documentation of CPAP intolerance or failure, and proof of structured weight loss attempts.

How to Check Your Insurance Coverage

Every insurance company has a range of coverage plans and each covers different drugs. The first place you can look is your insurance provider’s website. Most insurers have a formulary listed under each of their plans, so you can see exactly what’s covered and how much you can expect to pay.

Medicare and Medicaid have a similar list available online. If your insurance company’s online formulary is confusing or difficult to use, you can call the customer service number on the back of your insurance card to ask for copay information on any medication. 

You can also submit an appeal if your provider submits a GLP-1 request for approval and insurance says they won’t pay. Appeals can push insurers a little harder if they have denied payment for your weight loss drug or if it’s not on their list of approved medications. You may be able to get it covered with an appeal if your provider can prove it’s medically necessary. 

For most plans, you have six months to file an internal appeal with your insurer. If that appeal is denied, you can request an external review for a third-party to weigh in. Typically, appeals are submitted through your insurer’s website, but you may also request more information through their customer service.

Alternatives if Insurance Won’t Cover Ozempic

If your insurance plan won’t pay for Ozempic, you can ask about Zepbound or another GLP-1 medication. If no weight loss medication is covered, you still have options. Exercise and diet changes are encouraged for people on GLP-1s, and these changes improve sleep apnea symptoms on their own Trusted Source UpToDateMore than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights.View Source .

To lose weight through diet, create a calorie deficit: take in fewer calories than you use daily. Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source .

Cutting foods like sweet and alcoholic beverages, may also help you lose weight faster. However, everyone responds differently to diets, so you may need to try more than one approach. Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source . You should also talk to your doctor before making any big lifestyle changes, especially because they may be able to make medically-sound suggestions based on your history or refer you to a nutritionist.

You can also boost your calorie deficit by exercising.. The U.S. Department of Health and Human Services recommends getting 150 to 300 minutes of moderate-intensity exercise or 75 to 150 minutes of vigorous exercise each week. They also suggest you include muscle strengthening exercises at least two days per week . Adding resistance training is especially helpful because increased muscle mass improves metabolic rate.

Beyond lifestyle changes, your provider can recommend sleep apnea treatments like Trusted Source MSD ManualsFirst published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers.View Source : 

• CPAP (continuous positive airway pressure) therapy, which keeps your airways open while you sleep.
• Oral appliances that reposition or retrain your tongue to stay clear of your airway and prevent blockage.
• Surgical options like nerve stimulation, tonsil removal, and excess tissue removal to improve OSA symptoms through a variety of methods.

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