OptumRx GLP-1 prior authorization in 2026.
Roughly 65 million US covered lives in 2026. Used by UnitedHealthcare and others.
Plans administered by OptumRx
- UnitedHealthcare
- Many UnitedHealthcare Medicare Advantage plans
- Many state Medicaid managed care contracts
- Several large-employer self-insured plans
The OptumRx step-therapy quirk you should know about
OptumRx tightened GLP-1 criteria in 2025: BMI greater than or equal to 30 with one comorbidity OR BMI greater than or equal to 35, six months documented dietary intervention and step through phentermine or orlistat. Some employer carve-outs are stricter still and exclude obesity-indication GLP-1 entirely.
Expert tip
OptumRx is the PBM for most UnitedHealthcare plans. If you have UHC, the PA decision is made at OptumRx. The OptumRx formulary lookup tool at optumrx.com lets you check coverage tier and PA requirement before you send the letter.
The right plan-by-condition templates for OptumRx
Pick the template that matches your specific health plan and your qualifying indication. The plan and condition determine the PA criteria; the PBM determines how the letter is reviewed and submitted.
Other PBMs
