What can sleep physicians do when obstructive sleep apnea patients can’t afford every recommended therapy?
By Alyx Arnett
The approval of tirzepatide for adults with moderate to severe obstructive sleep apnea (OSA) and obesity has added another treatment option for sleep clinicians to discuss with patients. It has also raised new questions about affordability.
“When you layer on the cost of GLP-1 medications…the cumulative out-of-pocket burden can become substantial, particularly in situations where insurance only partially covers one or neither therapy,” says Claude Royster, senior vice president and general manager of wellness at Synchrony, which offers the CareCredit credit card.
Stakeholders say sleep physicians can help patients afford polytherapy by normalizing cost conversations, knowing which resources exist, and directing patients to assistance pathways before affordability becomes an adherence problem.
Polytherapy Costs
Royster points to CPAP equipment and GLP-1 medications as two categories that can create substantial out-of-pocket costs. Royster says CPAP costs can range from several hundred dollars to more than $1,000, while GLP-1 medications may cost about $1,000 per month in some cases.1
Coverage for tirzepatide, sold by Eli Lilly and Company as Zepbound for OSA with obesity, depends on a patient’s insurance plan and specific coverage criteria, according to a company spokesperson. The spokesperson says the company is working with stakeholders to close coverage gaps and notes that “nearly half of commercially insured Americans still lack access to obesity management medications.”
For sleep clinicians, it’s a challenge when a patient is prescribed multiple therapies but can only afford part of the plan. “That’s the hard part about me being a sleep doctor,” says pediatric neurologist-sleep physician Christopher Allen, MD, sleep science advisor at Aeroflow Sleep. “I can tell them all these wonderful things and say that you have these wonderful treatments, and they’re like, ‘Well, that’s great, but who’s going to pay for them?’”
Allen says he tries to discuss cost early, including testing costs, CPAP costs, and alternatives when appropriate. “If cost is a problem, I try to find solutions for them in their prospective cities,” Allen says. “There are ways to get treated.”
CPAP Costs
Allen says many patients do not understand the CPAP payment process before they receive a device. When patients obtain CPAP through insurance, he says, they are often placed in a rental arrangement that requires monthly payments for the device rather than receiving it outright.
Cost concerns can also arise from the adherence requirements tied to insurance coverage. “If they’re not using it, insurance can take it away,” Allen says. “The DME [durable medical equipment] company will retrieve that machine.”
Allen says the requirement can create a harmful cycle if patients are struggling with comfort, mask fit, pressure settings, or another problem but do not tell their sleep physician or DME supplier. If the device is returned, patients may have to start the process over, which can mean additional testing and costs.
Ongoing equipment costs can create additional adherence challenges, says Meg Langley, MPH, chief operating officer at the Wellness, Sleep & Circadian Network (WSCN), formerly the American Sleep Apnea Association. Langley says her organization hears from patients who are stretching supplies beyond their useful life.
“[They’re] taping their masking and tubing together, or they’re continuing to use worn-out equipment. They just can’t afford replacements,” Langley says. “If people aren’t finding the machine comfortable or aren’t finding it effective—because it’s an older machine or the supplies are breaking down—that’s going to be a problem for continued adherence.”
Pointing Patients to CPAP Assistance
One resource sleep physicians can share is WSCN’s CPAP assistance program. Patients who submit an application with a valid prescription can receive a new CPAP machine for a $200 processing fee. Langley says the machines are donated by medical device companies, set according to the patient’s prescription, and shipped in new, factory-sealed packaging.
“This program is to help people who need CPAP therapy but can’t access a machine or supplies through insurance or through an out-of-pocket purchase,” Langley says.
WSCN also offers low-cost supplies. Langley says one mask costs $25, two masks cost $45, and three masks cost $60. A yearly supply option, which includes four masks, four filters, and two tubes, costs $100.
For patients who cannot afford the $200 processing fee, Langley says WSCN has an option to apply for the equipment at no cost. In those cases, the application asks additional questions about the patient’s financial situation.
“We really just want to make sure these machines are accessible to people who need them,” Langley says.
According to Langley, the organization has shipped close to 20,000 packages since its inception, including machines and supply packages. As of May, WSCN had shipped 297 packages in 2026.
WSCN is currently shipping CPAP machines to approved applicants in select states and maintains a waiting list for other areas. For patients in states where machines are currently available, approved applications are typically processed quickly, with equipment shipping within 24 to 48 hours.
Local Assistance Programs
Allen says sleep physicians can also look for community-based resources that help patients afford testing and CPAP therapy. In Michigan, where he practices, Allen says some patients have received assistance through the Department of Human Services or related workforce-oriented programs.
He first learned about the assistance while working with patients whose jobs required sleep apnea evaluation, including commercial drivers subject to Department of Transportation requirements.
“They need to get a sleep study, and they found out that they have obstructive sleep apnea,” Allen says. “They may or may not have insurance, or if they do have insurance, their deductible is too high.”
Allen says some programs may help with testing and CPAP access, particularly when treatment supports a person’s ability to continue working. He recommends that physicians investigate what resources exist locally and keep a list of options for patients.
HSAs
Health savings accounts can also help some patients, Allen says, allowing them to set aside tax-free funds for eligible expenses. Insurance plan design can also matter. He says insurance coverage itself may also be worth revisiting in some cases. Depending on a patient’s circumstances and eligibility, Medicaid or Medicare programs may reduce out-of-pocket costs.
“It can be helpful if they can’t afford private insurance where they’re making payments or higher deductibles,” he says.
DME Choice
DME choice can matter as well, Allen says. He recommends that sleep physicians work with DME companies that clearly explain coverage options, expected costs, and alternatives that may be less expensive if purchased out of pocket. Aeroflow Sleep, where Allen serves as an advisor, says its process allows patients to enter insurance information so the company can research which CPAP options fit their coverage and what alternatives may be available.
Affordability Programs for GLP-1 Therapy
For patients prescribed Zepbound, Eli Lilly’s spokesperson says the company offers several access and affordability pathways based on insurance status. Self-pay patients or patients with commercial insurance that does not cover Zepbound may access the GLP-1 through LillyDirect starting at $299 per month, while eligible commercially insured patients may qualify for savings that reduce out-of-pocket costs to as low as $25 per month.
For employers, the company’s Lilly Employer Connect program allows employers to offer obesity management medication outside traditional pharmacy benefit designs, with Zepbound KwikPen available for $449.
The company’s spokesperson says those programs are intended to support affordability, continuity of care, and transparent pricing, noting that insurers and employers ultimately determine whether Zepbound is covered and under what criteria.
For Medicare beneficiaries, access may change beginning July 1, 2026, through the Medicare GLP-1 Bridge demonstration program. The Centers for Medicare and Medicaid program will provide eligible Medicare beneficiaries enrolled in Part D prescription drug plans access to certain GLP-1 medications for $50 per month through Dec 31, 2027.
Coverage availability for Zepbound may also expand for some commercially insured patients later in 2026, as CVS Caremark has announced plans to restore Zepbound to its standard commercial formularies beginning in October.
Financing as an Option
Patient financing is another option physicians can discuss with patients. Synchrony’s Royster says the company’s CareCredit can be used at participating locations for sleep services, CPAP therapy, copays, deductibles, and certain medications, including tirzepatide.
“The advantage for patients is that one CareCredit application unlocks a broad set of options; a patient who uses their card for a CPAP machine today can use that same card for their GLP-1 prescription tomorrow,” he says.
Royster cites company research showing that many patients continue to face affordability challenges. One study found 80% of surveyed Americans do not have dedicated savings for unexpected medical expenses,2 while separate research found that 59% of surveyed patients say there are not enough payment options available.3
Royster says providers also report limits in their ability to help patients find payment alternatives.
“A treatment plan without a financial plan is an incomplete plan,” he says.
GLP-1 Therapy Is Not Replacing CPAP
As patients take on the cost of both CPAP and GLP-1 therapy, clinicians may encounter questions about whether both treatments are necessary. According to Carlos Nunez, MD, chief medical officer at Resmed, weight-loss medications do not automatically eliminate the need for CPAP.
“While obesity is a risk factor for OSA, it is only one part of a much more complex condition,” Nunez says. “Weight management and CPAP therapy do not have to be mutually exclusive. Instead, they can play complementary roles in improving outcomes for people living with sleep apnea.”
Resmed’s analysis suggests that GLP-1 therapy may actually be associated with greater CPAP use rather than replacing it. Analysis of real-world data from IQVIA found that patients with prescriptions for both CPAP and a GLP-1 were about 11% more likely to start CPAP therapy than patients with CPAP prescriptions alone, according to Nunez. He says the analysis also found that patients prescribed both therapies were 3% more likely to resupply at one year and 6% more likely to resupply at three years.
For patients already on CPAP who later started GLP-1 therapy, Resmed found two-year CPAP resupply rates were 5.1% higher and three-year resupply rates were 6.2% higher than among patients on CPAP alone, according to Nunez.
“We continue to see that sleep apnea patients on a GLP-1 initiate CPAP therapy more often and stay on CPAP therapy longer, underscoring that these treatment methods are better together in treating OSA and promoting long-term adherence,” he says.
Nunez says the findings reinforce that weight loss does not necessarily eliminate OSA or the need for ongoing treatment. Even when weight-loss therapies improve the apnea-hypopnea index, some patients may continue to experience clinically significant breathing disruptions during sleep, he says. He also points to medication discontinuation as a reason to continue monitoring OSA over time.
“Even if patients see early success on GLP-1 therapy for treating OSA, they should stay engaged with their clinician and continue to monitor symptoms and sleep data over time,” he says.
What Physicians Can Do in the Exam Room
Allen says sleep physicians can help by making affordability part of the treatment conversation. These discussions can begin before the CPAP order and include lower-cost options when clinically appropriate, such as home sleep apnea testing instead of an in-lab study. He says the key is to make patients comfortable raising concerns early. “[Make] sure they know they have that support,” he says.
Additionally, Allen recommends explaining the CPAP process before the patient receives the device, including rental arrangements, adherence requirements, who to call if the mask or pressure is not working, and what could happen if the machine is not used enough. He also recommends asking about barriers at follow-up and not assuming nonadherence is a motivation problem.
Langley encourages clinicians to keep information about assistance programs available in the office. WSCN can provide patient flyers. “We want to spread the word more,” Langley says.
Ultimately, according to Royster, “Providers and their practice staff don’t need to become financial advisors.” But, he says, “recognizing that affordability barriers exist—and having a responsibly structured resource to point patients toward—is an increasingly vital part of delivering comprehensive care.”
References
- Synchrony. 2023-2025 Average procedural cost study for cosmetic, dental, veterinary, vision, and other practices across the United States. Conducted by ASQ360° Market Research.
- Synchrony Health & Wellness. Lifetime of healthcare costs research: A study of adult out-of-pocket spending, financial preparedness and the cost of delayed care. 2022.
- Synchrony. Healthcare journey research: Consumers and providers. 2023.
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