Does United Healthcare cover Wegovy for weight loss?

Wegovy is an injectable prescription medication approved by the Food and Drug Administration (FDA) for treating obesity. It is intended to be taken weekly in conjunction with diet and exercise to help people lose weight. Its active ingredient, semaglutide, is a glucagon-like peptide-1 (GLP-1) agonist. People see as high as 14.9% total body weight loss with Wegovy, according to clinical trials published in the New England Journal of Medicine.

Some United Healthcare (UHC) plans cover Wegovy for weight loss, but coverage varies by plan. We’ll outline UHC’s Wegovy coverage criteria and explain how to save with Wegovy coupons and discounts.

Wegovy for weight loss: Will UHC cover it?

It depends on the plan. For United Healthcare plans that cover Wegovy, the following standards apply. Note that state mandates and federal regulatory requirements may also impact coverage criteria.

UHC Wegovy initial authorization

On participating UHC plans, patients ages 12 and older may qualify for a four-month Wegovy prescription if they meet UHC’s criteria for Wegovy coverage:

• The patient is requesting treatment for appetite suppression or weight loss treatment.
• The patient will use Wegovy alongside lifestyle modification (e.g., dietary or caloric restriction, exercise, behavioral support, and community-based programs).
• The patient has a body mass index (BMI) at or above 30 kg/m² for adults or in the 95th percentile for pediatric patients. 

OR

• The patient has a BMI at or above 27 kg/m² with a weight-related medical condition such as high blood pressure, sleep apnea, or type 2 diabetes.

UHC Wegovy reauthorization

For participating plans, UHC members can request coverage for an additional 12 months of a Wegovy prescription if:

• The person taking Wegovy has lost at least 5% of their baseline body weight, and
• They are continuing to make lifestyle modifications.

How much does Wegovy cost?

Without health insurance, the typical cash price of Wegovy is approximately $1,833 for a 30-day supply (four injector pens), although that cost varies by pharmacy and doesn’t include any discounts. Since the cost varies by pharmacy, one pharmacy may charge hundreds more than another.

Even with insurance, Wegovy’s cost and coverage vary by insurance plan—contact your insurance provider for details. If your United Healthcare plan doesn’t cover Wegovy, consider using a SingleCare coupon card to make it more affordable. You can compare Wegovy pharmacy costs here.

How to check whether your United Healthcare plan covers Wegovy for weight loss

Find your UHC coverage details by logging in to your UHC health plan account online. Under your pharmacy and prescription coverage information, you’ll find your plan’s prescription drug list (PDL), where you can search for Wegovy. 

Another way to verify coverage is by using the Novo Nordisk costs and coverage tool.

You can also call the UHC member services number on the back of your insurance card to verify your specific insurance policy coverage. Novo Nordisk shares questions to ask your insurance company, such as:

• What will my copay be?
• Once I meet my deductible and out-of-pocket expenses, how much will my Wegovy copay be?
• Are there other ways to save? For example, would a 90-day prescription cost less?
• Are there any steps my healthcare provider or I should take, such as prior authorization?

Wegovy prior authorization

Prior authorization is an important topic to discuss with your insurance company. “Insurance plans have different requirements for weight loss medications,” explains Christie Kunde, Pharm.D., owner of InformedRx. “Some may cover Wegovy with no restrictions, while others may need prior authorization. Prior authorization criteria can vary, from having the right diagnosis to trying other medications first.”

For those looking to streamline prior authorization for Wegovy, Suneye Koohsari, MD, owner of Manhattan Medical Weight Loss, recommends assembling a history of your chronic weight management efforts and sharing them with your healthcare provider. You can include efforts such as:

• Prior diets, medications, or weight loss programs
• Start and end dates for each program or medication
• Effectiveness, side effects, and reasons for discontinuation of previous treatments

“This information will be invaluable for your medical team in expediting the prior authorization process,” Koohsari says. 

How to save on Wegovy

There are other ways to save on Wegovy if your UHC plan doesn’t cover it. 

Free Wegovy coupons

A SingleCare Wegovy coupon card offers sizable savings. Depending on the pharmacy, you can save nearly $600 per month. All you need to qualify for the coupon is a valid Wegovy prescription and citizenship in the United States or Puerto Rico.

Find your free SingleCare Wegovy coupon card here, then:

1. Type in your zip code.
2. Customize dosage and quantity.
3. Choose your preferred pharmacy.
4. Click “Get free coupon.” 
5. Click “Save coupon” or enter your email or phone number. 
6. Show your pharmacist the coupon during checkout. 

Wegovy manufacturer savings card

Novo Nordisk offers support and discounts through NovoCare. With NovoCare’s Wegovy Savings Offer, you may get a 28-day Wegovy supply for as low as a $0 copay. You can save up to $225 when using this discount card with insurance and up to $500 without insurance. 

Wegovy insurance coverage

The Wegovy website offers tips for gaining Wegovy insurance coverage. There’s also a sample Wegovy coverage request letter for those with private or employer-sponsored insurance.

NovoCare recommends asking these questions to an insurance company that does not cover Wegovy:

• Are there any other options to get Wegovy covered by insurance? If so, what steps are required?
• Are exceptions or appeals accepted? If so, what steps are required?

Wegovy alternatives

If your UHC plan doesn’t cover Wegovy, there are other options for weight loss. Some medications have weight loss as a side effect but are approved for other conditions. For example, Mounjaro is approved to treat Type 2 diabetes, but it also reduces appetite. Without a weight-related condition, you may not be eligible for insurance coverage, but your healthcare provider may be able to prescribe it off-label. Talk to your healthcare provider about your options.

For added support, UHC offers Real Appeal, a healthy lifestyle and weight management program. Real Appeal is free through participating UHC insurance plans and provides online coaching, on-demand workouts, and science-backed health resources. Call the number on the back of your UHC membership card to see if your plan is eligible for Real Appeal benefits.