Eli Lilly’s obesity drug, Zepbound, is now eligible for coverage under Medicare insurance for the treatment of sleep apnea, expanding access to the popular weight-loss medication.
The Centers for Medicare & Medicaid Services (CMS) made the announcement Wednesday. This comes after Zepbound became the first drug in the U.S. to be approved for sleep apnea treatment in December. For Medicare to cover obesity drugs, they must be approved for a secondary use, such as treating other conditions, by the Food and Drug Administration (FDA).
Before this decision, many commercial insurers and employers were hesitant to cover the drug due to its high price, which exceeds $1,000 per month. While CMS has provided this guidance, insurers still have the option to opt out of covering Zepbound.
Last year, Eli Lilly’s competitor, Novo Nordisk, received Medicare coverage for its obesity drug Wegovy to help reduce the risk of heart attacks and strokes. Both Lilly and Novo are actively testing their weight-loss drugs for additional health benefits, as they race to prove their broader therapeutic potential.
In November, the Biden administration proposed expanding Medicare coverage for obesity treatments. If the incoming administration, under President-elect Donald Trump, supports the expansion, the changes could take effect in 2026.
Medicare covers roughly 65 million people, including those aged 65 and older, as well as people with disabilities.
Sleep apnea, which affects an estimated one billion people worldwide, causes brief pauses in breathing during sleep. This disrupts the sleep cycle and can lead to serious health issues, such as heart disease.
Common treatments for sleep apnea include CPAP (continuous positive airway pressure) machines, surgery, and weight loss. Zepbound, along with Lilly’s diabetes drug Mounjaro, is part of a class of medications known as GLP-1 agonists. Analysts predict the market for GLP-1 drugs could exceed $150 billion annually by the early 2030s.
