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You must have either: Tried CPAP (used 4+ hours/night, 70%+ of nights) but still have symptoms, OR Can't use CPAP for medical reasons No diabetes your A1C (blood sugar test) must be 6.5% or lower Sleep specialist involvement must be prescribed by or in consultation with a sleep specialist Received counseling on sleep position and avoiding alcohol/sedatives before bed No planned surgeries for sleep apnea or weight loss Must be obstructive sleep apnea only not central or mixed types To keep coverage: After 12 months, you'll need to show at least 10% weight loss and improved sleep study scores to continue on Wegovy

Compliance review pass (per CLAUDE.md Rule 5) No health/medical/performance claims