MedicaidPrior AuthMedium impact
2025.32 - Provider Bulletin - Zepbound for Treatment of Obstructive Sleep Apnea
Connecticut Medicaid (HUSKY Health)·CT · Sleep Medicine, Pulmonology, Family Medicine +1 more·Provider Bulletin
Effective date
Jul 1, 2025
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid will cover Zepbound for obstructive sleep apnea treatment starting July 1, 2025, but requires prior authorization and specific diagnostic criteria including AHI ≥15 and concurrent PAP therapy. Providers must submit PA forms with diagnosis code G4733 for all new prescriptions and annually thereafter.
Action Required
By July 1, 2025: Providers prescribing Zepbound for sleep apnea must obtain prior authorization forms from www.ctdssmap.com under Pharmacy Information tab. Ensure diagnosis code G4733 is submitted in Field 424-DO on pharmacy claims. Complete PA requests for new therapy and annually thereafter with required clinical documentation (AHI ≥15, PAP therapy use, lifestyle interventions). Incomplete PA forms will be denied.