J3285 Insurance Policy Changes

Zepbound® (tirzepatide) (Revised)

Humana Medicare Advantage has revised its prior authorization policy for Zepbound (tirzepatide) to cover a NEW indication: moderate to severe obstructive sleep apnea (OSA) in adults with obesity. Previously, Zepbound was only approved for weight loss; this expansion requires prior authorization based on specific OSA diagnostic criteria (AHI/REI ≥15, BMI ≥30, documented lifestyle modifications). Billing teams must implement prior auth requirements for all Zepbound claims under this new OSA indication effective immediately.