Does United Healthcare cover Wegovy for weight loss?

Wegovy (semaglutide) is a once-weekly injectable prescription medication that’s FDA-approved for weight loss and cardiovascular risk reduction in people with obesity and overweight. If you’ve been prescribed Wegovy for weight loss, and you have health insurance through UnitedHealthcare, you’re probably wondering if Wegovy is covered by your plan. 

The short answer is: it depends. Read on as we explain whether UnitedHealthcare covers Wegovy for weight loss and share savings tips if your plan doesn’t.

As with most insurance companies, whether UnitedHealthcare covers Wegovy depends on the specific coverage offered by your plan. Some UnitedHealthcare plans do not cover Wegovy, as some employers may choose not to cover weight loss medications in their insurance plans. When UnitedHealthcare does cover Wegovy for weight loss, prior authorization is typically required. At the time of writing, this is a two-step process. Here’s how it works.

Step 1: Initial authorization for Wegovy

UnitedHealthcare may approve initial authorization for Wegovy if you meet all of the following conditions:

• You are taking Wegovy either for weight loss or for cardiovascular risk reduction (if you also have heart disease).

• You are 12 years of age or older.

• You plan to use Wegovy in addition to lifestyle changes such as diet, exercise, health coaching, or a weight loss program.

• You meet the body mass index (BMI) requirements to take Wegovy (i.e. children ages 12 and up have a BMI in the 95th percentile or above, adults 18 and over have either a BMI of 30 or higher or 27 or higher with a weight-related health condition).

If you meet all of these conditions, UnitedHealthcare may cover Wegovy for four months. To keep getting coverage for Wegovy, you’ll need to get reauthorization, which we explain in Step 2 below.

Step 2: Reauthorization for Wegovy

UnitedHealthcare may approve reauthorization and cover Wegovy for an additional 12 months after initial authorization if you meet two conditions:

1. You must have lost at least 5% of your body weight during your first four months of taking Wegovy; and

2. You plan to continue the lifestyle changes you made, such as diet and exercise.

You’ll need to work with your healthcare provider on both the initial authorization and reauthorization. They’ll submit the proper forms to UnitedHealthcare on your behalf.

Note that if you’re prescribed Wegovy for cardiovascular risk reduction and meet UHC’s coverage criteria, you may be eligible to get Wegovy covered for up to 24 months (12 months with initial authorization plus another 12 months with reauthorization). If you have heart disease, talk with your provider to see if you qualify.

How to tell if your UnitedHealthcare plan covers Wegovy

To find out if your UnitedHealthcare plan covers Wegovy, call the service number on the back of your insurance card. You can also find a contact number for your plan on the UHC website, or contact them via chat in the UHC app. 

If you log in to the UHC website, you can also find the Prescription Drug List, or PDL, for your plan. This will show you the list of drugs covered by your plan, along with their associated cost tier.

Novo Nordisk, the maker of Wegovy, also offers an online tool you can use to check if your insurance covers Wegovy. Once you enter some information, the tool will share your coverage details. If it can’t find any coverage information, you can ask Novo Nordisk to contact UnitedHealthcare on your behalf. Have your insurance card handy.

Regardless of how you contact UnitedHealthcare, you might want to ask them a few more questions beyond, “Do you cover Wegovy?” This way, you’ll have a better understanding of what’s covered and how much you can expect to pay for Wegovy. 

• Does my UnitedHealthcare plan cover Wegovy?

• What steps do I need to take to get coverage for Wegovy? What’s needed for initial authorization and reauthorization?

• What is my copay for Wegovy?

• Do I need to meet a deductible or out-of-pocket limit first before my copay applies? If so, how close am I to meeting those for the year?

• Is my UnitedHealthcare plan considered a commercial plan?

• Do I need to use a specific pharmacy to fill my prescription for Wegovy?

• If my plan doesn’t cover Wegovy, what steps can I take to get coverage?

Novo Nordisk has listed these questions on a PDF that you can print out and complete during your conversation with your insurance company.

Wegovy is FDA-approved for two uses: weight loss and cardiovascular risk reduction. It can be prescribed to:

• Adults who have a BMI of 30 or higher (defined as “obesity”)

• Adults who have a BMI of 27 or higher (defined as “overweight”) and a weight-related health condition, such as high cholesterol, high blood pressure, type 2 diabetes, or sleep apnea

• Adults who have heart disease and either obesity or overweight

• Children ages 12 and up who have a BMI in the 95th percentile for their age and sex

Some people should avoid taking Wegovy. For example, people with a personal or family history of certain thyroid cancers, including medullary thyroid carcinoma (MTC) and Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) should not take Wegovy. Additionally, people who are pregnant should not take Wegovy, and both men and women who plan on trying to conceive should stop taking Wegovy at least 2 months beforehand. 

Also, if you have experience with any of the following health conditions, tell your healthcare provider prior to taking Wegovy. You may be more likely to experience potentially serious side effects on Wegovy, so they may want to monitor you more closely during your treatment or recommend an alternative weight loss medication instead.

• Pancreatitis

• Gallstones or gallbladder issues

• Kidney problems

• Diabetic retinopathy

Without insurance, Wegovy costs $1,349.02 for a one-month supply. However, depending on the pharmacy you use, your prescription drug coverage, and whether you have any pharmacy discounts or savings cards, your payment may be higher or lower than that.

If UnitedHealthcare won’t cover Wegovy, there are still ways you can save at the pharmacy. For example, you can:

• Send a coverage request letter to your employer. Novo Nordisk offers an example on their website. Share this with your healthcare provider and ask them to print it out on their letterhead. Then, you can bring that to your benefits manager at your work to see if they can get your insurance to cover Wegovy.

• Apply for the Wegovy Savings offer. Novo Nordisk also has a Wegovy coupon that offers significant savings on the cost of Wegovy, even if your UHC plan doesn’t cover it. If your plan covers Wegovy, you might be able to get Wegovy for free with this coupon. If your plan includes prescription drug coverage, but won’t cover Wegovy, you’ll pay $650 for a one-month supply. The Wegovy coupon is only eligible for people with commercial or private insurance, and some restrictions apply. 

• Use pharmacy discount cards. Many websites, such as GoodRx, SingleCare, and Optum Perks, offer discount cards for pharmacies across the country. Check to see if your pharmacy has a discount card on any of these websites.

• Ask your healthcare provider about Wegovy alternatives. Wegovy is one of several GLP-1 medications for weight loss, including Saxenda (liraglutide) and Zepbound (tirzepatide). It’s possible that one of these other medications could be covered by your UnitedHealthcare plan. Another option, compounded semaglutide, can be more affordable out of pocket if your insurance plan will not cover weight loss medications. 

Sometimes, getting coverage for Wegovy can take a little work, but if your UnitedHealthcare plan covers Wegovy, a few extra steps can make it an affordable medical weight loss option.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

August 14, 2024

Written by

Amelia Willson

Fact checked by

Patricia Weiser, PharmD

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About the medical reviewer

Patricia Weiser, PharmD

Patricia Weiser, PharmD, is a licensed pharmacist, health content writer, and medical reviewer with more than a decade of clinical experience in community and hospital pharmacy.