{"id":630093,"date":"2024-10-14T11:13:38","date_gmt":"2024-10-14T15:13:38","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=630093"},"modified":"2025-12-11T14:22:15","modified_gmt":"2025-12-11T19:22:15","slug":"does-united-healthcare-cover-ozempic","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-united-healthcare-cover-ozempic\/","title":{"rendered":"Does United Healthcare cover Ozempic?"},"content":{"rendered":"

Around 12% of all Americans report having taken <\/span>Ozempic<\/span><\/a> (semaglutide) or another GLP-1 drug (like Wegovy). And among U.S. adults diagnosed with Type 2 diabetes, that number skyrockets to 43%, according to <\/span>a 2024 KFF survey<\/span><\/a>. Ozempic is a popular prescription drug right now, not just for its approved use for Type 2 diabetes, but also because of its <\/span>off-label<\/span><\/a> weight loss benefits. If you\u2019re one of the many people who are curious about Ozempic, you may know that it\u2019s not one of the cheapest medications on the market, averaging over $1,300 per month without insurance. But if you have insurance, you might pay far less.<\/span><\/p>\n

Insurance plans will often cover Ozempic when it\u2019s medically necessary, but it depends on your specific health insurance plan and the reason for taking it. Read on for all the important details.<\/span><\/p>\n

Does United Healthcare cover Ozempic?<\/span><\/h2>\n

Like most insurance-related questions, it\u2019s slightly more complicated than a simple yes or no. \u201cMany insurance policies have insured their clients for Ozempic, especially when it has been prescribed by a doctor on the grounds of medical necessity and declared as such,\u201d according to Dr. Michael O. McKinney, MD, a physician specializing in weight loss at <\/span>Healthy Outlook<\/span><\/a>. \u201cHowever, the terms of this insurance coverage and any copayments or deductibles associated with it vary.\u201d<\/span><\/p>\n

Insurance companies typically have many different plans, each with its own formulary\u2014also known as a prescription drug list (PDL)\u2014and its own policies. The only way to confirm your coverage is to check your plan\u2019s formulary. While many plans cover Ozempic, coverage depends on which tier they place it on, affecting your copay. And there may be prior authorization requirements as well.<\/span><\/p>\n

Drug tier<\/span><\/h3>\n

Even if a health insurance plan covers Ozempic, you still might have some out-of-pocket costs. Prescription drug plans organize covered drugs into a series of tiers, which dictate how much of the cost they\u2019ll cover. Tier 1 consists primarily of low-cost generic drugs, while the higher tiers contain brand-name drugs and specialty medications. The higher the tier, the more you\u2019ll typically pay. Many United Healthcare (UHC) plans have three or four tiers, and most put Ozempic in tier 2 or tier 3, meaning you\u2019ll probably still be responsible for certain copay or coinsurance costs and deductibles.<\/span><\/p>\n

Prior authorization<\/span><\/h3>\n

On top of that, many UHC plans require <\/span>prior authorization<\/span><\/a> for Ozempic and other GLP-1 medications. This is how insurance companies make sure a particular drug is medically necessary for the patient before issuing coverage. The specifics depend on the plan but may require additional paperwork from the prescribing healthcare provider or a process called <\/span>step therapy<\/span><\/a>\u2014trying other, often less expensive, drugs first. Some UHC plans also have quantity limits, which put a cap on how much a healthcare provider can prescribe at one time.<\/span><\/p>\n

If you have a Medicare Part D or Medicare Advantage plan through United Healthcare, they typically operate the same way. <\/span>Medicare may cover Ozempic<\/span><\/a> if it is prescribed for Type 2 diabetes, but not weight loss. The same is true with <\/span>Medicaid<\/span><\/a>, but each state determines its own coverage policies, so it depends on where you live.\u00a0\u00a0<\/span><\/p>\n

Does United Healthcare cover Ozempic for weight loss?<\/span><\/h3>\n

It\u2019s complicated. The Food and Drug Administration (FDA) <\/span>has approved Ozempic for\u00a0 Type 2 diabetes<\/span><\/a> as well as to reduce the risk of major adverse cardiovascular events (such as heart attack or stroke) in adults with Type 2 diabetes and cardiovascular disease. However, one of the reasons it\u2019s so popular is because weight loss is a side effect, which is why healthcare providers may prescribe it off-label for weight loss.\u00a0<\/span><\/p>\n

A Gallup poll<\/span><\/a> showed that around 15.5 million Americans reported using Ozempic or similar medicines to lose weight. But this has led to <\/span>Ozempic shortages<\/span><\/a>, directly affecting people with Type 2 diabetes who rely on the drug.\u00a0<\/span><\/p>\n

That\u2019s why the drug\u2019s manufacturer, Novo Nordisk, introduced <\/span>Wegovy<\/span><\/a>, which includes the same active ingredient as Ozempic\u2014semaglutide\u2014but with different dosages and indications. According to Dr. McKinney, \u201cWegovy is authorized for chronic weight management only in clients with obesity or overweight with associated comorbidity, so it could likely be granted coverage of weight loss under UHC plans. However, this also depends on the type of plan and the medical history of the patient in question.\u201d In addition to weight management, Wegovy is also FDA approved to reduce the risk of major adverse cardiovascular events in adults with cardiovascular disease and either obesity or overweight.<\/span><\/p>\n

UHC often only covers Wegovy<\/span><\/a> if the patient:<\/span><\/p>\n