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Key takeaways
Some UnitedHealthcare plans cover Rybelsus, but coverage varies by insurance plan.
Rybelsus coverage may depend on the specific plan’s drug formulary, the enrollee’s diagnosis, and whether prior authorization paperwork has been completed.
Without insurance, Rybelsus costs about $1,349 per month. With insurance, the monthly cost may be limited to a fixed copay.
To find out if your UHC plan covers Rybelsus, check the plan’s drug formulary or contact your insurance representative.
Rybelsus (semaglutide) is an FDA-approved medication used to lower blood sugar in adults with Type 2 diabetes. Ryblesus has the same active ingredient as Ozempic, another popular diabetes treatment. The difference? Rybelsus is a once-daily oral medication, whereas Ozempic is a once-weekly injection (similar to the discontinued drugs Adlyxin and Bydureon BCise). Other drugs in the same therapeutic class, but with a different active ingredient, include Victoza (liraglutide), Byetta (exenatide), and Trulicity.
As a brand-name medication, Rybelsus isn’t cheap. Some insurance plans may cover it when prescribed for diabetes (not weight loss), but exact coverage varies by provider and health plan.
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Does UnitedHealthcare cover Rybelsus?
The short answer: It depends on your plan. Prescription drug benefit coverage varies by plan, even within the same insurance company. UnitedHealthcare (UHC) is a huge company—the largest insurer in the U.S. in terms of total market value, according to S&P Global—so it’s impossible to give a single answer that applies to all UHC plan enrollees.
Several factors can affect insurance coverage for Rybelsus, including:
- Why you take it
- How the medication is categorized on your plan’s drug formulary
- Whether you need prior authorization
- Whether there are quantity limits
- What type of plan you have
Reason for taking Rybelsus
Most commercial insurance plans cover GLP-1 agonists like Rybelsus for diabetes, according to Dr. Supriya Rao, MD, gastroenterologist and clinical assistant professor at Tufts University School of Medicine. Almost all prescription drug coverage is contingent on the drug being taken for an FDA-approved condition.
Most Rybelsus users are aware that the semaglutide in their medication lowers blood sugar levels by stimulating insulin production in the pancreas. However, semaglutide also suppresses appetite, so some people take Rybelsus off-label for weight loss. While Rybelsus often does reduce body weight, it’s not approved as a weight loss drug. UnitedHealthcare will not cover Rybelsus solely for weight loss.
Drug formulary
Another factor influencing Rybelsus coverage is its categorization on your healthcare plan’s list of covered drugs, also known as the prescription drug formulary.
UHC drug formularies separate drugs into three or four tiers. The drug’s tier determines the copay you will have for each refill. Tier 1 consists of the lowest-cost prescription medications (usually generic medications). The highest tier consists of the most expensive drugs, including high-cost drugs like Zepbound for weight loss or specialty medications like Folistim AQ for infertility.
Under the AARP Medicare Advantage plan from UHC, Rybelsus is listed as a Tier 3 drug. However, different UnitedHealthcare plans may categorize Rybelsus differently.
Prior authorization
In most cases, UHC plans only cover Rybelsus when there is medical documentation that the person has been diagnosed with Type 2 diabetes mellitus and that the drug is medically necessary. This type of requirement is known as prior authorization, a standard insurance process for high-cost medications.
Quantity limits
Quantity limits restrict some prescription drug benefits. That’s true for Rybelsus coverage under the AARP Medicare Advantage from UHC, and it may be true for other UHC plans as well. If you’re concerned that your monthly Rybelsus dose exceeds the limit, talk to your healthcare provider.
Other factors affecting Rybelsus coverage
Dr. Rao notes that some insurance providers and plans require additional documentation before covering Rybelsus, a high-cost medication. She notes that some plans require step therapy (proof that a lower-cost treatment, such as metformin, has been tried first), a recent A1c test, or documentation that the patient has received lifestyle counseling to help manage their diabetes.
How much does Rybelsus cost?
Before insurance or other discounts, the current average price of Rybelsus is $1,349 per 30 tablets of 7 milligrams (mg). That means people without insurance or financial assistance could pay more than $16,000 per year for this diabetes medication.
The good news is that even people without insurance can save on the cash price of medications. For instance, a SingleCare coupon for Rybelsus can lower the cost to as little as $874 for a 30-day supply of 7 mg tablets. Exact prices and discounts vary by location and pharmacy.
How much does Rybelsus cost with UnitedHealthcare?
People with insurance rarely pay the full cash price for a medication. UHC plan members may need to undergo prior authorization for Rybelsus coverage, but once coverage is authorized, they will pay a copay—a fixed out-of-pocket cost—for every Rybelsus refill. Copays vary by plan and drug tier.
Some examples:
- People enrolled in AARP Medicare Rx Preferred from UHC (PDP) pay a $47 copay for a 30-day supply of Tier 3 drugs.
- People enrolled in UnitedHealthcare Group Medicare Advantage (PPO) pay a $40 copay for a 30-day supply of Tier 3 drugs.
Bottom line: The cost of Rybelsus with UHC insurance is considerably lower than the retail price as long as your prescription plan’s drug formulary includes the drug.
How to check whether your UnitedHealthcare plan covers Rybelsus
Again, Rybelsus coverage depends on your specific UnitedHealthcare plan. The best way to check for insurance coverage of Rybelsus or any other drug is to review your plan’s drug formulary. The formulary will also list whether Rybelsus requires prior authorization and/or is subject to quantity limits.
You can find your healthcare plan’s drug formulary by logging in to your UHC plan at uhc.com/sign-in.
You can also call the number on the back of your health insurance card. A representative will need you to read off your account and group numbers on the card to look up your drug formulary.
Factors influencing UHC Rybelsus coverage
Several factors will influence whether UHC covers your Rybelsus prescription. These include, but are not limited to:
- Your specific UHC plan
- The drug tier in which Rybelsus is categorized on your plan’s formulary
- Whether or not you have a Type 2 diabetes diagnosis
- Whether or not your healthcare provider can provide documentation for prior authorization
Bottom line: Every UHC plan is different. It’s difficult to predict if your plan covers Rybelsus. The best way to find out is to log into your healthcare plan online or contact UnitedHealthcare directly.
Is UHC good for managing diabetes?
Dr. Rao says the answer depends on your exact plan, employer group, and diabetes treatment. “I have UHC patients who get [GLP-1 medications] approved quickly when we meet the checklist and others who face strict step edits or higher tier,” she says.
The cost of diabetes can be shockingly high. Although UnitedHealthcare includes many plans that cover some or all costs of diabetes medications and supplies, it is a very large insurance company. Some plans may offer coverage for expensive, brand-name drugs, such as Rybelsus, while others may not.
UHC offers a workplace insurance plan called Level2, which provides specialized coverage for wearable diabetes care technology for eligible employees with Type 2 diabetes. If you have UHC insurance through your workplace, contact your insurance representative to obtain more information about this plan.
Finally, some people prefer UHC for managing diabetes because insurance coverage through such a large insurance company may provide accessibility to more care providers. This benefit may depend on your location and plan.
How to save on Rybelsus
There are ways to save on Rybelsus even without a UHC benefit plan that covers this medication. Consider checking if you qualify for financial assistance from the drug manufacturer, Novo Nordisk. You can also lower the price by using a SingleCare discount card or a Rybelsus coupon at a participating pharmacy.
- Highlights of prescribing information, Novo Nordisk (2024)
- Level2, UnitedHealthcare
- Complete drug list (formulary) 2025, UnitedHealthcare (2024)
- UnitedHealthcare pharmacy clinical pharmacy programs, UnitedHealthcare (2025)
- UnitedHealth remains largest U.S. insurer by market cap after 40% hit in Q2 2025, S&P Global (2025)
- Summary of benefits 2025 AARP Medicare Rx Preferred from UHC (PDP), UnitedHealthcare (2025)
- Summary of benefits 2025 UnitedHealthcare Group Medicare Advantage (PPO), UnitedHealthcare (2025)