Is Wegovy Covered by UnitedHealthcare?
Yes.
Coverage varies by plan, but many UnitedHealthcare (UHC) commercial and Medicare Advantage plans include Wegovy for weight management and cardiovascular risk reduction, subject to prior authorization Curex+10SingleCare+10Honest Care+10San Francisco Chronicle+12UHC Provider+12Ro+12.
Does Wegovy Require Prior Authorization?
Yes, prior authorization is required.
Documentation must include:
- Verified BMI and comorbid conditions
- Descriptions of prior weight-loss efforts
- Treatment plan and dosing schedule UnitedHealthcare+13UHC Provider+13partner.medica.com+13SingleCare+2Curex+2SingleCare+2.
Are There Limits to Wegovy Coverage?
Yes.
Eligibility Criteria
- BMI Requirements: Adults must have a BMI ≥ 30, or ≥ 27 with at least one weight-related comorbidity (like type 2 diabetes, hypertension, dyslipidemia, or sleep apnea); pediatric patients qualify at the 95th percentile BMI UHC Provider+1SingleCare+1.
- Cardiovascular Risk: UHC may also approve Wegovy for adults with existing cardiovascular disease, even if BMI is lower UnitedHealthcare+13UHC Provider+13Ro+13.
- Lifestyle Efforts: Coverage requires participation in a structured diet, exercise, or behavior modification program Honest Care+2Ro+2Curex+2.
Initial & Continued Therapy
- Initial Approval: UHC typically authorizes Wegovy for up to 5 months for adults and 4 months for pediatric patients UHC Provider+1Reddit+1.
- Reauthorization: Continued coverage is granted if the patient achieves ≥ 5% weight loss from baseline and maintains lifestyle intervention UHC Provider+1Honest Care+1.
⚖️ Exclusions & Limits
- Some employer-specific or formularies may not cover Wegovy at all (non-formulary situations) Honest Care.
- Patients who fail to show weight loss or maintain lifestyle modification may lose coverage.
- Non-medical use or off-label prescribing is likely to be denied SingleCare+11Curex+11Honest Care+11.
What Documentation Is Needed?
Your provider must include:
- Patient’s current BMI, age, and comorbid conditions
- History of structured weight management attempts
- Clinical justification and dosage plan
- Statements on participation in lifestyle modification programs
What if Coverage Is Denied?
- You can appeal using supporting clinical documentation.
- UHC’s prior-authorization unit can be contacted at 1‑800‑711‑4555 UHC Provider+2partner.medica.com+2Reddit+2Curex+1SingleCare+1UHC ProviderReuters+15UnitedHealthcare+15Honest Care+15.
- Discuss the potential use of manufacturer assistance programs if denied.
Policy Updates & News
- In June 2025, UHC joined other major insurers pledging to simplify prior authorization, including maintaining authorization for 90 days when patients switch plans SingleCare+3Reuters+3San Francisco Chronicle+3.
Summary
- Many UHC plans do cover Wegovy, but only under strict prior authorization and eligibility criteria.
- Patients must show ≥ 5% weight loss during initial coverage period to continue treatment.
- Approved use includes weight reduction and cardiovascular risk management.
- Documentation and adherence to lifestyle plans are essential.
- Keep an eye on changing plan formularies. Policies may shift each year.
What You Should Do Next
- Check your policy. Log in to UHC member portal or call customer service to confirm if Wegovy is covered.
- Work with your provider to assemble required info: BMI, comorbidities, lifestyle program participation, and clinical plan.
- Submit prior authorization through provider/pharmacy using UHC’s criteria.
- Track your progress. A ≥ 5% weight loss is needed for reauthorization.
- Follow up on appeals promptly if coverage is denied.