A woman is suing Elevance Health after being denied coverage for Zepbound — Eli Lilly’s weight-loss drug — to treat her sleep apnea, a court filing said.
According to the complaint, the FDA approved Zepbound “as the first and only prescription medication” to treat moderate to severe cases of obstructive sleep apnea.
Elevance does not cover Zepbound for this use case, despite covering other FDA-approved and prescribed drugs. Obstructive sleep apnea is listed as a covered medical condition under Elevance’s Anthem Plan, and other Anthem formularies include Zepbound. The class-action suit claims the denial violates terms of Elevance’s plans and the Employee Retirement Income Security Act.
Elevance covers other drugs known for weight loss that also serve different purposes, such as Ozempic and Mounjaro for conditions like Type 2 diabetes, the lawsuit says.
Amy Newkirk, the plaintiff, and the proposed class are requesting relief to recover their benefits. Ms. Newkirk also seeks $110 for each day Elevance did not provide her with administrative claim records.
Becker’s contacted Elevance and will update this story if a comment is received.
