​On May 1, 2025, Independence Blue Cross (IBX) Select Drug Program® and Value Formularies ended coverage of Zepbound (tirzepatide) for the treatment of moderate to severe obstructive sleep apnea (OSA). The change went into immediate effect on May 1, 2025, for new prescriptions. For patients (members) with an existing prescription, coverage ends on August 1, 2025, or when their insurance plan is renewed, whichever comes first.

Zepbound's benefits are limited to weight loss, and currently there are no clinical studies to support that the drug treats OSA through any other mechanism. This coverage change aligns with IBX's recent update to exclude coverage of weight loss drugs.

Members' benefits regarding GLP-1 medications

Members who have a weight loss benefit through their employer still have coverage for
GLP-1 medications, including Zepbound. It's always important to use the Eligibility & Benefits transaction in the Practice Management application on the Provider Engagement, Analytics & Reporting (PEAR) portal to confirm your patients' eligibility, coverage limitations, prior authorization requirements, and any associated out-of-pocket costs. This step ensures transparency and helps facilitate timely access to these treatments.

Available OSA treatment options

IBX offers coverage for other OSA treatment options, including continuous positive airway pressure (CPAP) machine, bi-level positive airway pressure machine (BIPAP), special mouthpiece devices, and nerve stimulators when criteria are met. Surgical treatment may be an option for some members.

For more information on pharmacy coverage and guidelines, visit the Pharmacy Resource Page.

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