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Using a Markov state-transition model over a 20-year horizon, the analysis integrates SUMMIT trial outcomes with long-term cost projections from a U.S

For the OSA indication, separate criteria apply: Polysomnography documenting moderate-to-severe OSA (typically AHI 15+) BMI 30 or higher CPAP intolerance, insufficiency, or contraindication documentation Sleep medicine physician co-signature in some plans The December 2024 OSA pathway The FDA's December 2024 approval of tirzepatide (Zepbound) for moderate-to-severe obstructive sleep apnea in adults with obesity, based on the SURMOUNT-OSA trials (Malhotra et al., New England Journal of Medicine 2024), created a new coverage pathway

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