FDA Approves Weight-loss Drug Zepbound For Sleep Apnea – Will Insurance Cover This $1000-Per-Month Medication?

The U.S. Food and Drug Administration (FDA) recently approved Zepbound® (tirzepatide) as the first prescription medication for treating moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity. Manufactured by Eli Lilly and Company, Zepbound offers a new approach to managing OSA symptoms while also promoting significant weight loss.

What Is Zepbound?

Zepbound is an injectable prescription medication created to help adults with obesity and weight-related problems, including obstructive sleep apnea. OSA causes airway collapses during sleep and symptoms include snoring, fatigue and excessive daytime sleepiness. If left untreated, OSA can lead to serious health complications like cardiovascular issues and cognitive impairments.

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According to a recent news release, Eli Lilly's clinical trials for Zepbound showed promising results. After one year, patients experienced an average of 25 fewer breathing interruptions per hour. Furthermore, up to 50% of participants no longer exhibited symptoms of OSA. The medication also promotes weight loss, with patients losing an average of 45 pounds or 18% of their body weight, during the trials.

"Too often, OSA is brushed off as ‘just snoring'—but it's far more than that," Julie Flygare, president and CEO of Project Sleep, said in the news release. "We hope this will spark more meaningful conversations between patients and health care providers and ultimately lead to better health outcomes."

How Does Zepbound Work?

Zepbound is a dual-activating medication that combines glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) mechanisms to tackle the root causes of obesity. It suppresses appetite and reduces caloric intake, making it particularly effective for individuals whose OSA symptoms are exacerbated by excess weight.

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The drug can be used with or without CPAP treatment. While Zepbound alone showed significant efficacy, patients combining it with PAP therapy saw even greater benefits, including a higher likelihood of symptom remission.

What Does Zepbound Cost?

Lilly Investors have listed Zepbound for $1,086.37 per fill. But the actual costs will vary depending on each patient's insurance coverage of prescription drugs. Those who have commercial drug insurance may qualify to pay as low as $25 for a one to three-month supply of Zepbound. For those whose commercial drug insurance does not cover Zepbound, they may be eligible to pay $650 for a one-month supply of the drug. 

Without insurance, patients would need to pay the full price, plus additional pharmacy charges that may apply. 

Eli Lilly has stated its commitment to making the drug accessible, offering savings programs to eligible patients and planning to release more data on average out-of-pocket costs in the coming months.

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Will Insurance Cover Zepbound?

There will likely be insurance coverage for Zepbound as a sleep apnea treatment; however, as a newly approved medication, specific insurance pricing is not currently available. It may also take time for insurers to determine how it fits into their formularies. It is also good to note that insurance coverage for this medication will vary depending on your policies. 

Lilly Investors encourages patients to consult with their health care providers and insurers to explore coverage options and eligibility for savings programs.

The FDA's approval of Zepbound provides a new approach to treatment for Americans who struggle with OSA and obesity. Patients considering Zepbound should discuss the potential benefits, risks and costs with their doctors. 

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