Will Insurance Cover Ozempic for Sleep Apnea?

Key Takeaways

• Insurance generally does not cover Ozempic for sleep apnea, because the drug is FDA-approved to treat type 2 diabetes—not obstructive sleep apnea.
• Weight loss from GLP-1 medications may help reduce sleep apnea symptoms for some people, though Ozempic itself is not an approved sleep apnea treatment.
• FDA-approved alternatives for sleep apnea are available, including CPAP therapy and newer medications like Zepbound specifically approved to treat sleep apnea in people with obesity.

How Ozempic Works for Sleep Apnea

Though Ozempic isn’t currently FDA-approved as a sleep apnea treatment, some research suggests that semaglutide, the active component of Ozempic, and similar drugs may reduce OSA symptoms. These drugs, called glucagon-like peptide-1 receptor agonists (GLP-1s), may help some people with obstructive sleep apnea by promoting weight loss.

Although not FDA-approved for weight loss, either, Ozempic is often referred to as a weight-loss drug, because people tend to lose weight while on it. GLP-1 medications, including Ozempic, may promote weight loss by slowing how quickly the stomach is emptied, making people feel more satisfied with less food, and reducing overall appetite.

Weight loss has been closely associated with improvement in sleep apnea symptoms, as it may help by redistributing fat, reducing soft tissue that presses on the upper airway, and reducing fat in the tongue.

Insurance Coverage for Ozempic for Sleep Apnea

Because Ozempic isn’t FDA-approved to treat sleep apnea or obesity, health insurance companies don’t cover it for these purposes. Ozempic is only FDA-approved to treat type 2 diabetes and related risks. That said, type 2 diabetes and obstructive sleep apnea have considerable overlap, so some people with sleep apnea may qualify for a prescription.

Studies show that about 60% to 80% of people with type 2 diabetes also have obstructive sleep apnea, and 15% to 30% of people with OSA have type 2 diabetes. This means some people with OSA could be prescribed Ozempic for type 2 diabetes and potentially receive additional benefits due to weight loss, improved inflammation, and possible other mechanisms that need further exploration.

There are also injectable drugs similar to Ozempic that can be prescribed for obesity or obstructive sleep apnea specifically and may be covered by Medicare or private health insurance. 

Wegovy is another brand name for injectable semaglutide. Also manufactured by Novo Nordisk, Wegovy is FDA-approved to help people with overweight or obesity over age 12 lose weight. Although not specifically designed or approved to treat sleep apnea, the drug could prompt weight loss, reduced inflammation, and improved respiratory control that may help reduce sleep apnea symptoms.

Additionally, Zepbound was the first — and is currently the only — injectable medication that’s FDA-approved to treat obstructive sleep apnea. Specifically, the drug treats adults with moderate to severe sleep apnea and obesity by promoting weight loss. While it's a GLP-1s like Ozempic and Wegovy, Zepbound is also a glucose-dependent insulinotropic polypeptide (GIP) receptor agonist.

Like Ozempic, both Wegovy and Zepbound should be used alongside lifestyle changes, like eating less and engaging in more exercise.

How to Check Your Insurance Coverage

If you want to find out if your health insurance covers Ozempic or other similar injectable medications, like Wegovy (now available both as an injectable and oral medication) or Zepbound, follow these steps:

1. Meet with your doctor and share your symptoms to find out if they consider you a good candidate for any of these medications. You cannot access GLP-1s without a prescription, so obtaining a prescription is the first step toward obtaining the medication.
2. Call your health insurance company and ask if they cover the medication you have been prescribed. (The best phone number to call is often the one on the back of your insurance card.) If they say they do cover the medication, ask if prior authorization is required. Also, clarify how much of the cost they will cover, as well as the dollar amount you will owe as a co-pay each month.
3. If prior authorization is required, reach out to your doctor's office. Ask them to fill out and submit the required paperwork for prior authorization before you fill the prescription. 

Another way to check your insurance coverage is with the help of the pharmaceutical companies. Novo Nordisk provides online forms you can fill out to identify if your health insurance will cover Ozempic or Wegovy prescriptions. Eli Lilly also provides a website dedicated to helping you understand insurance coverage for the Zepbound drug.

Alternatives if Insurance Won’t Cover Ozempic

If your health insurance doesn’t cover Ozempic, you may be able to get coverage for another drug, like Wegovy or Zepbound, that could have similar effects. Sometimes, though, you might find that you don't have coverage for any of the GLP-1 drugs. In this case, you might want to look into discount options provided by the pharmaceutical companies. Many offer discounts to make the medications more affordable.

If GLP-1 drugs aren’t available to you, there are still other options you can pursue. For example, when obstructive sleep apnea is caused or worsened by obesity, lifestyle changes on their own have been found to improve symptoms. These changes generally involve eating a healthier diet and becoming more physically active to maintain a healthy weight.

That said, lifestyle changes and weight loss alone are often not enough to completely eliminate obstructive sleep apnea. In these cases, tried and true treatments like nightly use of a CPAP machine can help. Oral appliances worn during sleep or surgeries to help keep the airway open are often other sleep apnea treatment options.