Coverage at a glance
| Indication | Coverage |
|---|---|
| Obesity / chronic weight management (plans that elected weight-loss coverage) | Covered with prior authorization |
| Cardiovascular risk reduction and MASH (a liver disease) (Wegovy, plans without weight-loss coverage) | Covered with prior authorization |
| Obstructive sleep apnea (Zepbound, plans without weight-loss coverage) | Covered with prior authorization |
If your plan denies coverage, two cash programs to check.
No insurance needed.
- Strut Health$149 a month, with auto-refillcompounded semaglutideCheck price →You pick Weight Loss, then a five-minute online visit
- Shed$199 a monthcompounded semaglutideCheck price →Every medication is listed with a starting price
Cheapest GLP-1 without insurance compares the three cash routes. Cheapest GLP-1 ranks every cash price on the chart.
Prior authorization: the plan reviews the prescription before it pays.
UnitedHealthcare runs its weight-loss coverage as an optional program. Its own 2026 policy opens by calling it "an optional program that is put in place for clients or businesses that have elected to cover weight loss products." If your employer bought that benefit, Wegovy and Zepbound are covered once the plan signs off. The bar is BMI 30, or BMI 27 with a weight-related condition. If your employer did not buy it, weight loss is excluded, and only three narrower routes are left: Wegovy for cardiovascular risk reduction, Wegovy for MASH, and Zepbound for sleep apnea. This answer covers Commercial job-based plans, both fully insured and self-funded.
Source: UnitedHealthcare policy 2026 P 1114-21. Checked August 15, 2026.
What it costs once they say yes. With commercial insurance the manufacturer savings card takes Wegovy or Zepbound to as little as $25 a month. Your plan sets the copay before the card applies. What Wegovy costs with your plan. What Zepbound costs with your plan.
This varies by plan. The weight-loss prior-authorization program is optional. It runs only for employers that chose to cover weight-loss products. The separate non-formulary policies for Wegovy and Zepbound both say that "medications for the purpose of weight loss are typically a benefit exclusion." So two people holding identical UnitedHealthcare cards can get opposite answers, depending on who they work for. Read the prescription drug section of your summary plan description. Or call member services on your card and ask straight out whether your plan covers weight-loss medications. OptumRx is the pharmacy benefit manager.
Coverage by indication
| BMI threshold | BMI 30 or higher, or above the 95th percentile for a child. BMI 27 or higher also qualifies with a weight-related condition. The policy names dyslipidemia, hypertension, type 2 diabetes and sleep apnea as examples. |
| Step therapy | None. The 2026 criteria do not make you try phentermine, orlistat or any other weight-loss drug first. They ask only that the drug be used alongside lifestyle change. The policy describes that as a restricted diet or fewer calories, exercise, behavioral support, or a community-based program. It sets no minimum length for it. |
| Continuation | You lose 5 percent or more of the body weight you started with, and you keep up the lifestyle change |
| Authorization length | The Wegovy shot or tablet, 5 months to start. Zepbound, 6 months to start. Either one runs 12 months when it is renewed. |
What the prior authorization needs:
- Your employer has to have chosen weight-loss drug coverage. Program 2026 P 1114-21 runs only on plans that did.
- Age 12 or older for Wegovy injection, and older than 16 for Zepbound
- Documented BMI within the accepted threshold
- A written record of the weight-related condition, where your BMI is 27 to 29.9
- Used as an adjunct to lifestyle modification
- Reauthorization requires 5 percent loss of baseline body weight
Source: UnitedHealthcare policy 2026 P 1114-21. UnitedHealthcare's own prior-authorization program PDF, downloaded from uhcprovider.com and read in full.
This is the route for members whose plan does not cover weight-loss drugs. The policy says that "medications for the purpose of weight loss are typically a benefit exclusion." It then allows the Wegovy shot, or the tablet, to lower cardiovascular risk. It allows the Wegovy shot for MASH. A qualifying BMI is not enough here. Approval turns on a written record of established cardiovascular disease, or of MASH.
| BMI threshold | BMI 27 or higher |
| Cardiovascular criteria | Established cardiovascular disease, shown by a prior heart attack (myocardial infarction), a prior stroke from a clot or a bleed, or symptomatic peripheral arterial disease. Peripheral arterial disease counts when the record shows intermittent claudication, meaning cramping leg pain on walking, with a resting ankle-brachial index below 0.85, or a peripheral arterial revascularization procedure to restore blood flow, or an amputation caused by atherosclerotic disease. |
| Step therapy | No weight-loss drug has to be tried first. Instead the patient must already be on guideline-directed cardiovascular therapy from each class that applies, unless a drug is contraindicated or not tolerated. That means a cholesterol-lowering medication for all three histories, a beta blocker for a prior heart attack, an ACE inhibitor, ARB or ARNI, and an antiplatelet. |
What the prior authorization needs:
- Age 45 or older
- BMI 27 or higher
- Documented established cardiovascular disease
- Guideline-directed cardiovascular therapy taken alongside it, from each class that applies, unless a drug is contraindicated or not tolerated
- Used with a reduced-calorie diet and increased physical activity
Source: UnitedHealthcare policy 2026 P 1445-4. UnitedHealthcare's own non-formulary prior-authorization PDF, downloaded from uhcprovider.com and read in full.
This is the route for members whose plan leaves weight-loss drugs out. The policy says that "medications for the purpose of weight loss are typically a benefit exclusion." It then allows Zepbound for obesity with obstructive sleep apnea.
| BMI threshold | BMI 30 or higher |
| Sleep study (AHI) | Moderate to severe obstructive sleep apnea on a sleep study. That means an apnea-hypopnea index, respiratory event index or respiratory disturbance index above 15 events an hour |
| Step therapy | PAP is the step, in effect. The patient has to still have obstructive sleep apnea symptoms while adhering to PAP, which the policy defines as at least 4 hours a night on at least 70 percent of nights. Or the record has to document that the patient is not a PAP candidate. |
| Continuation | Under 52 weeks on the drug, any documented drop from baseline in the AHI, RDI or REI. At 52 weeks or more, a drop of 50 percent from baseline. Either way you also have to have lost 10 percent of your starting body weight. |
| Authorization length | 6 months initial. Reauthorization 6 months under 52 weeks of therapy, 12 months at 52 weeks or more. |
What the prior authorization needs:
- Age 18 or older
- BMI 30 or higher
- Sleep study documenting AHI, REI or RDI above 15 events per hour
- At least one previous unsuccessful dietary effort to lose weight
- Symptoms carry on even while the patient sticks with PAP, or the file says the patient is not a candidate for PAP
- No diabetes diagnosis and A1c at or below 6.5 percent
- The prescriber confirms in writing that they counseled the patient on positional therapy, and on avoiding alcohol or sedatives before bed
- No surgery planned for sleep apnea or obesity. No sleep apnea that is mostly central or mixed
- Prescribed by or in consultation with a sleep specialist
Source: UnitedHealthcare policy 2025 P 1475-2. UnitedHealthcare's own non-formulary prior-authorization PDF, downloaded from uhcprovider.com and read in full.
Recent change: The P&T committee at UnitedHealthcare signed off on the weight-loss program three times, in November 2025, in February 2026 and in April 2026. The version that runs now took effect on July 1, 2026. The 2026 criteria ask only that the drug be used alongside lifestyle change. They set no minimum length for it. To renew, you need 5 percent weight loss.
Ozempic, Mounjaro and Rybelsus on UnitedHealthcare plans
Ozempic, Mounjaro and Rybelsus are approved for type 2 diabetes, not weight loss.
Does UnitedHealthcare cover Ozempic?
Yes, with prior approval. UnitedHealthcare pays for Ozempic once your prescriber gets the plan to sign off.
UnitedHealthcare covers Ozempic for adults with type 2 diabetes on its 2026 commercial drug list. OptumRx runs the sign-off, and a quantity limit applies. Approval needs records confirming a type 2 diabetes diagnosis. An A1C of 6.5 percent or higher does that, and so does another qualifying lab value. For a patient diagnosed more than two years ago, chart notes are accepted. The 2026 policy has no step therapy, and an approval lasts 12 months. UnitedHealthcare does not cover Ozempic for weight loss. That use is off-label, and most plans leave it out. Weight loss is Wegovy's indication, the same semaglutide at a higher dose.
Checked August 27, 2026.
What UnitedHealthcare requires for Ozempic
| Step therapy | Not required |
What the prior authorization needs:
- The plan has to sign off, under UnitedHealthcare clinical program 2026 P 1332-8, in force from July 1, 2026.
- Medical records confirming type 2 diabetes, shown by one of these. An A1C at or above 6.5 percent. A fasting plasma glucose at or above 126 mg/dL. A 2-hour plasma glucose at or above 200 mg/dL on an oral glucose tolerance test. Or a random plasma glucose at or above 200 mg/dL with the classic symptoms of high blood sugar.
- For patients diagnosed more than 2 years ago, chart notes confirming the type 2 diabetes diagnosis are accepted.
- Authorization is issued for 12 months.
- No step therapy. The April 2024 revision cut the note saying it may apply.
- A quantity limit applies, per the 2026 commercial drug list in force from January 1, 2026. On that list Ozempic also carries an 'E'. That means a plan in Connecticut, New Jersey or New York may exclude it or require prior authorization.
- The FDA has not approved it for weight loss. Plans usually leave drugs used for weight loss out of the benefit.
Source: UnitedHealthcare policy 2026 P 1332-8. The plan's own coverage policy.
Recent change: UnitedHealthcare revised this GLP-1 program in April 2024, and that revision cut the old note saying step therapy may apply. So the 2026 program does not make you try metformin before it approves Ozempic for type 2 diabetes. The program was reaffirmed at annual review, and took effect on July 1, 2026.
Does UnitedHealthcare cover Mounjaro?
Yes, with prior approval. UnitedHealthcare pays for Mounjaro once your prescriber gets the plan to sign off.
UnitedHealthcare covers Mounjaro for type 2 diabetes on its commercial plans, once the plan signs off. OptumRx handles that sign-off. To approve it, the plan asks for records confirming a type 2 diabetes diagnosis, and an approval runs 12 months. UnitedHealthcare will not cover Mounjaro for weight loss, because the FDA approved it for type 2 diabetes only. Zepbound is the weight-loss version of the same drug, tirzepatide, and UnitedHealthcare handles that one under a separate policy.
Checked August 27, 2026.
What UnitedHealthcare requires for Mounjaro
| Step therapy | Not required |
What the prior authorization needs:
- Prior authorization is required, handled through OptumRx.
- Medical records confirming a type 2 diabetes diagnosis, shown by one lab value. An A1C of 6.5% or higher. A fasting plasma glucose of 126 mg/dL or higher. A 2-hour glucose of 200 mg/dL or higher on an oral glucose tolerance test. Or a random glucose of 200 mg/dL or higher with symptoms.
- For patients diagnosed more than two years ago, medical records confirming the type 2 diabetes diagnosis are enough.
- No step therapy is required.
- Supply limits may apply.
- Approval is issued for 12 months.
Source: UnitedHealthcare policy 2026 P 1332-8. The plan's own coverage policy.
Recent change: UnitedHealthcare cut the step therapy rule for Mounjaro in its April 2024 update. Patients no longer have to try another diabetes drug and fail it first. The current policy, in force from July 1, 2026, keeps that change.
Does UnitedHealthcare cover Rybelsus?
Yes, with prior approval. UnitedHealthcare pays for Rybelsus once your prescriber gets the plan to sign off.
UnitedHealthcare and OptumRx cover Rybelsus for type 2 diabetes on commercial plans, once the plan signs off. Approval needs medical records confirming a type 2 diabetes diagnosis. An A1C of 6.5% or higher does that. So does a fasting plasma glucose of 126 mg/dL or higher, or another qualifying glucose value. A patient diagnosed more than two years ago can qualify on records confirming the diagnosis. Rybelsus is not covered for weight loss. The FDA approved it for type 2 diabetes only, and plans usually leave weight-loss drugs out. Wegovy is the weight-loss version of semaglutide.
Checked August 27, 2026.
What UnitedHealthcare requires for Rybelsus
| Step therapy | Not required |
What the prior authorization needs:
- Prior authorization required.
- Medical records confirming a type 2 diabetes diagnosis, shown by one of these. An A1C of 6.5% or higher. A fasting plasma glucose of 126 mg/dL or higher. A 2-hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test. Or a random plasma glucose of 200 mg/dL or higher with the classic symptoms of high blood sugar.
- For a patient who needs ongoing treatment and was diagnosed more than 2 years ago, medical records confirming the type 2 diabetes diagnosis.
- No step therapy in the current program. The April 2024 update cut the metformin trial.
- Authorization is issued for 12 months.
Source: UnitedHealthcare policy 2026 P 1332-8. The plan's own prior-authorization policy.
Recent change: The current program is 2026 P 1332-8, approved by the P&T committee in April 2026 and in force from July 1, 2026. The April 2024 revision cut step therapy from this program, so a metformin trial is no longer required. Some third-party summaries still print a metformin step. The current policy does not have one.
What to do next
If you qualify under one of the covered indications above, prior authorization is the path. Match the documentation in the requirements list then have your prescriber submit it. Plans that approve reassess at renewal, so know your long-term maintenance dose before you start.
- Browse the prior-authorization letter library for a template that matches your plan and indication.
- Read why plans say no and the four ways to appeal in the GLP-1 insurance guide.
- Your plan may treat another GLP-1 differently. The UnitedHealthcare coverage check lists all 4, with the source for each.
- If the plan denies it, the appeal letter library has a template for each reason a plan gives. That covers the peer-to-peer call with a plan doctor, the Level 1 and Level 2 appeals inside the plan, and the outside review that follows them.
- Call the number on your insurance card and ask whether your specific plan includes the weight-management drug benefit before you submit.
- If your plan does not cover the indication you need, compare cash prices in the cost guide or check whether a clinical trial near you fits. Neither one goes through your insurer. Clinical trials cost nothing and many pay you for your time.
What it costs without insurance
The programs below bill you directly. Prices checked every Monday.
Frequently asked questions
Does UnitedHealthcare cover Wegovy for weight loss?
Only if your employer elected the benefit. UnitedHealthcare's weight-loss prior-authorization program (2026 P 1114-21, effective July 1, 2026) is described in the policy itself as optional and put in place for clients that have elected to cover weight-loss products. On plans that elected it, Wegovy is approved at BMI 30 or higher, or BMI 27 or higher with a weight-related comorbidity such as dyslipidemia, hypertension, type 2 diabetes or sleep apnea, used as an adjunct to lifestyle modification. Initial authorization runs 5 months. Reauthorization runs 12 months and requires 5 percent loss of baseline body weight plus continued lifestyle modification. On plans that did not elect it, Wegovy is covered only for cardiovascular risk reduction or MASH under a separate non-formulary policy.
Does UnitedHealthcare cover Zepbound?
On plans that elected weight-loss coverage, yes, with prior authorization, under the same BMI thresholds as Wegovy. Initial authorization runs 6 months, reauthorization 12 months, and reauthorization requires 5 percent loss of baseline body weight. On plans that did not elect weight-loss coverage there is one remaining route: Zepbound for moderate to severe obstructive sleep apnea, under policy 2025 P 1475-2. That route is narrow. It requires BMI 30 or higher, a sleep study showing an apnea-hypopnea index above 15, no diabetes diagnosis and A1c at or below 6.5 percent, a prescription written by or in consultation with a sleep specialist, and either continued symptoms despite PAP adherence of at least 4 hours a night on 70 percent of nights, or documentation that you are not a PAP candidate.
What BMI does UnitedHealthcare require for GLP-1 coverage?
BMI 30 or higher, or BMI 27 or higher with a weight-related comorbidity. The 2026 policy names dyslipidemia, hypertension, type 2 diabetes and sleep apnea as examples rather than as a closed list. Pediatric patients qualify at a BMI above the 95th percentile. The sleep-apnea pathway for Zepbound on plans without weight-loss coverage uses a stricter threshold: BMI 30 or higher, with no BMI 27 option. The cardiovascular pathway for Wegovy uses BMI 27 or higher and additionally requires the patient to be 45 or older.
Why might UnitedHealthcare deny Wegovy even if I meet the BMI criteria?
The most common reason has nothing to do with your BMI. It is that your employer never bought the weight-loss benefit, which UnitedHealthcare's own non-formulary policies describe as the typical case. Beyond that: the reauthorization gate at 5 percent weight loss ends coverage for people who respond slowly; the cardiovascular pathway requires documented guideline-directed therapy from each relevant drug class (statin, beta blocker, ACE inhibitor or ARB, antiplatelet) unless contraindicated; and the sleep-apnea pathway requires a sleep specialist and documented PAP failure or non-candidacy. If the benefit was never elected, no amount of clinical documentation fixes it. The route is a formulary exception, an appeal on the benefit design, or a different plan at open enrollment.
Does UnitedHealthcare cover Zepbound for sleep apnea?
Yes, with prior authorization. This is the route for members whose plan leaves weight-loss drugs out. The policy says that "medications for the purpose of weight loss are typically a benefit exclusion." It then allows Zepbound for obesity with obstructive sleep apnea. UnitedHealthcare states this in UnitedHealthcare Pharmacy Clinical Pharmacy Programs, Prior Authorization/Non-Formulary: Zepbound (tirzepatide), Obstructive Sleep Apnea Only, Program 2025 P 1475-2, effective March 1, 2026, read August 2026.
Coverage for other payers
See the full payer coverage index for every plan we have sourced.
How we built this page
Every page here comes from the payer's own policy, a federal law, or KFF's plan research. Each row links its source and gives the date we read it. Some plan files load at the address the payer gives but will not open. We check those against a second source and mark the row lower confidence. Job-based plans also choose whether to add the weight-drug benefit at all, so those rows say varies by plan rather than a flat yes.
This is reference information, not medical or legal advice, and not a guarantee of coverage. GLP-1 coverage policies change often. Always confirm the current policy with your insurer using the number on your card before you rely on this page. If your experience differs from what is shown here, email hello@glpchart.com with the details and we will re-verify.
