CPAP and Zepbound

[53richart]

I have been a nightly CPAP user since 2016 and while I am fully compliant I very seldom get a good nights sleep, most likely because I am so obese (BMI 41.3).

I am on regular Medicare with a Plan G supplement and Part D drug plan which, unfortunately, does not have Zepbound in its formulary (none offered in my zip code do.) In order to make my CPAP therapy better I am about to start taking Zepbound and pay out of pocket.

However my pulmonologist thinks there is a chance I could get an exception so that my Part D provider would cover it. Towards that goal I completed a home sleep study (WatchPAT) last night (without CPAP) and received a copy of the results this afternoon. Of course all the numbers and charts don't mean too much to me, but it does indicate I have severe OSA, pRDI 33.6, pAHI 32.2.

Has anyone taken Zepbound to lose weight and then had a better CPAP experience with more restful sleep? And has anyone been successful in getting an exception to their Part D drug plan so that it covers Zepbound? If so, I would love to hear your experience.

[Justin Case]

Well, for starters, you need to start adding paragraphs because your post is very hard to read. It's unreasonable to expect readers to copy and paste your post and run it through AI for a clean, easy to read option.

Zepbound is the brand name for tirzepatide, the same medication sold as Mounjaro for diabetes. It's in the same family as Ozempic and Wegovy, and has received a tremendous amount of exaggerated media attention.

One thing that's typically lost in the headlines is that the improvements seen in obstructive sleep apnea patients are of a secondary outcome in nature as it relates to weight loss.

The medication isn't treating the airway directly. The medication is helping (some) people lose weight that their sleep apnea may improve. In that sense, the benefits are similar to what has long been observed after bariatric surgery, diet, and exercise: lose a substantial amount of weight, and in these "rare" examples, some see reductions in OSA severity, lower CPAP pressure requirements, and better sleep quality (with caveats—see below). A few lucky ones (unicorns) may discontinue CPAP, while the masses still need it. Those are quite extreme examples of success and again, mentioning this in the media is typically ignored. Many MDs who don't think critically ignore this reality and view these jabs as the magic bullet.

Basically. the real "treatment" for OSA in this context is the weight loss itself, regardless of whether it's achieved through lifestyle changes, bariatric surgery, or a medication like tirzepatide which does work better than Ozempic but it's still quite low in the real world at the recommended doses.

Here's the kicker, though. Post-marketing (real-world) experience has identified effects that were not apparent in Eli Lilly's pre-approval clinical trials. There is evidence that GLP-1 receptor agonists and tirzepatide can affect the central and autonomic nervous systems. In a small subset of particularly sensitive individuals, those effects may be counterproductive, with insomnia emerging as a side effect that appears to be independent of glycemic control, gastrointestinal symptoms, or other more commonly recognized adverse effects.

[Mijjil]

You need to apply for the Medicare GLP-1 Bridge - Zepbound for a $50/month copay! My physician did all the paperwork.

[53richart]

You need to apply for the Medicare GLP-1 Bridge - Zepbound for a $50/month copay! My physician did all the paperwork.

If you have Type 2 Diabetes, moderate-to-severe Obstructive Sleep Apnea (OSA), or metabolic dysfunction-associated steatohepatitis (MASH/fatty liver disease), you are explicitly excluded from using the Bridge Program. Which I means I will have to go through the process of asking my Part D provider to cover Zepbound as an exception (and then probably an appeal or two of their initial decision.)

[Mijjil]

If you have Type 2 Diabetes, Mounjaro should already be covered by Medicare.

[stevenal]

The Bridge OSA exclusion will exclude most of us here.

This is a "short term demonstration" for a drug that's generally taken for life. The program will likely to end just when all is going smoothly.
Keeping it separate from Part D means the $50/month does not go toward your Part D deductible or maximum out of pocket.
Seems like a bad deal all around.