Does UnitedHealthcare cover Ozempic?

UnitedHealthcare’s coverage of Ozempic (semaglutide) may vary by plan. Many UnitedHealthcare plans cover Ozempic for type 2 diabetes. But does UnitedHealthcare cover Ozempic for weight loss? Usually, the answer is no. 

UnitedHealthcare (UHC) is a private insurer that administers many types of health plans, including commercial and employer-based plans, as well as Medicare, Medicaid, and other plans. The coverage details described in this article mainly applies to UHC’s commercial and employer-based plans. Actual Ozempic coverage varies by specific plan and should be confirmed directly with UHC. 

UnitedHealthcare generally covers Ozempic when it is prescribed for type 2 diabetes, but not when it is prescribed for weight loss. When UnitedHealthcare does cover Ozempic, it is usually as a more expensive Tier 2 or Tier 3 drug (which have higher co-pays than lower-tier or generic drugs). Prior authorization is also typically required.

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Does UnitedHealthcare cover Ozempic for weight loss? 

No, UnitedHealthcare generally does not cover Ozempic for weight loss. Weight loss is an off-label use of Ozempic, and insurance plans typically only cover drugs when they are prescribed for a condition listed on the official labeling. UHC typically covers Ozempic injection or tablet for FDA-approved uses:

• Control blood sugar levels in adults with type 2 diabetes, along with diet and exercise

• Reduce the risk of major cardiovascular (CV) problems in adults with type 2 diabetes who also have cardiovascular disease or a high risk for CV problems 

• Reduce the risk of worsening disease, kidney failure, and CV death in adults with type 2 diabetes and chronic kidney disease (injection only)

However, some UHC plans may cover other weight loss medications, including:

• Wegovy (semaglutide), a weekly GLP-1 injection containing the same active ingredient as Ozempic, but in higher dosage strengths approved for weight loss

• Wegovy pill, an oral version of Wegovy taken daily

• Saxenda (liraglutide), a daily GLP-1 injection for weight loss

• Zepbound (tirzepatide), a weekly GLP-1 injection for weight loss

• Qsymia (phentermine/topiramate), a daily weight loss pill

• Contrave (naltrexone/bupropion), a daily weight loss pill

• Xenical (orlistat), a daily weight loss pill

Because some UHC plans cover the above medications for weight loss, it may be tougher to get UHC to cover Ozempic off-label for weight loss under their off-label prescribing policy.

Yes, you need prior authorization for Ozempic on UnitedHealthcare. Prior authorization refers to paperwork your healthcare provider can submit online to UHC confirming that Ozempic is a medically necessary treatment for you. For UHC to cover Ozempic, your prior authorization must show that you are an adult with a diagnosis of type 2 diabetes based on:

• An HbA1c level of 6.5% or greater

• Fasting plasma glucose (FPG) of 126 mg/dL or higher

• 2-hour plasma glucose (PG) of 200 mg/dL or higher during an oral glucose tolerance test

• Random plasma glucose of 200 mg/dL or higher with signs of hyperglycemia (high blood sugar)

If your type 2 diabetes was diagnosed more than two years ago, your healthcare provider can submit medical records or chart notes confirming your diagnosis.

If UHC approves your prior authorization for Ozempic, the approval will last for 12 months. According to UnitedHealthcare, the insurance company approves the majority of prior authorization requests, and most are approved within 24 hours after they receive the documentation from your healthcare provider.

Here are three ways you can check if your UnitedHealthcare plan covers Ozempic:

1. Contact UHC by calling the number on the back of your insurance card.

2. Sign in to the UHC member website to view your Prescription Drug List (PDL), which is a list of all the drugs covered by your plan.

3. Use Ro’s free GLP-1 insurance coverage checker.

If your UHC plan covers Ozempic, make sure to check the coverage details, too. For example, what cost tier does it fall under, and is prior authorization required? This will give you an idea of your expected co-pay and whether you need to coordinate prior authorization with your healthcare provider.

Ozempic costs around $1,000 at the pharmacy without insurance or discounts, based on the manufacturer’s list price for a 1-month supply. If your UnitedHealthcare plan covers Ozempic, it may have a higher co-pay as a Tier 2 or Tier 3 drug. You can lower your cost further by signing up for the manufacturer savings offer, if eligible, which lowers the monthly cost of Ozempic to as low as $25.

If UnitedHealthcare won’t cover Ozempic, you can try the following:

• Pay cash for Ozempic. Telehealth programs such as Ro offer access to Ozempic for self-pay patients. You can also use the Novo Nordisk savings program, which offers the Ozempic injection for self-pay prices of $199–$499, depending on the dose, and $149–$299 for the Ozempic pill, also depending on the dose.

• See if UHC will cover another GLP-1 for diabetes instead. UnitedHealthcare may cover Mounjaro (tirzepatide), Trulicity (dulaglutide), or generic liraglutide. Like Ozempic, these also require prior authorization.

• Switch insurance plans. If you purchased insurance coverage on the ACA Healthcare Insurance Marketplace (i.e. through HealthCare.gov), open enrollment usually starts November 1. Also, be aware that other insurance plans, including BCBS and Aetna, may also only cover Ozempic for type 2 diabetes, and not weight loss.

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Getting insurance to cover GLP-1s such as Ozempic usually means jumping through at least a few hoops. UnitedHealthcare is no exception. Here is an overview of UHC's coverage of Ozempic:

• UnitedHealthcare typically only covers Ozempic for type 2 diabetes, not off-label prescriptions such as weight loss or fatty liver disease.

• Prior authorization is required before UHC will cover Ozempic, and must show that you are an adult with a diagnosis of type 2 diabetes.

• You can check if your UnitedHealthcare plan covers Ozempic by logging in to your member website, calling the number on your insurance card, or using Ro’s free GLP-1 insurance checker.

• The cost of Ozempic can be as low as $25 with UHC coverage and the manufacturer savings offer; otherwise, it can range from $149 to $1,000.

• If your UHC plan won’t cover Ozempic, you can pay cash for Ozempic, see if your plan will cover another GLP-1 medication instead, or switch insurance plans during open enrollment.