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Does UnitedHealthcare cover Ozempic for Type 2 Diabetes?

Yes. UnitedHealthcare covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy on file; the document isn't available to view online yet.

  • Employer and ACA Marketplace: Covered with requirements. See the qualification pathways below.

Earliest policy review June 2, 2026. How we verify · Check your exact plan

Full requirements: Ozempic for Type 2 Diabetes (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

New T2DM diagnosis (diagnosed ≤ 2 years ago)

All of:

  • Submission of medical records (e.g., chart notes) confirming diagnosis of type 2 diabetes mellitus

Plus any one of:

  • A1C ≥ 6.5%
  • Fasting plasma glucose (FPG) ≥ 126 mg/dL
  • 2-hour plasma glucose ≥ 200 mg/dL during oral glucose tolerance test
  • Random plasma glucose ≥ 200 mg/dL in patient with classic symptoms of hyperglycemia or hyperglycemic crisis

Ongoing T2DM treatment (diagnosed > 2 years ago)

All of:

  • Submission of medical records (e.g., chart notes) confirming diagnosis of type 2 diabetes mellitus
  • Patient diagnosed greater than 2 years ago

Documentation to bring

  • Medical records (e.g., chart notes) confirming diagnosis of type 2 diabetes mellitus
  • For new diagnosis (≤2 years): at least one qualifying lab value (A1C ≥ 6.5%, FPG ≥ 126 mg/dL, 2-hr PG ≥ 200 mg/dL on OGTT, or random PG ≥ 200 mg/dL with classic hyperglycemia symptoms)
  • For ongoing treatment (>2 years): chart notes confirming T2DM diagnosis

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Re-authorization may be based solely on previous claim/medication history, diagnosis codes (ICD-10), and/or claim logic via automated processes.

Not covered when

  • Not approved for weight loss; use solely for weight loss is not covered
  • Type 1 diabetes

Policy note: This policy covers Ozempic for T2DM under this PA program. Ozempic also has FDA-approved CV risk reduction and CKD indications noted in the background section, but this PA policy only establishes criteria based on T2DM diagnosis. Automated approval/re-approval processes may apply. Supply limits may be in place.

Policy effective July 1, 2025 · verified June 2, 2026 · source: PA Notification Diabetes Agents GLP-1 Receptor Agonists

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Questions people ask
Does UnitedHealthcare cover Ozempic?
Yes. UnitedHealthcare covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with UnitedHealthcare?
Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does UnitedHealthcare require to renew Ozempic?
Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Re-authorization may be based solely on previous claim/medication history, diagnosis codes (ICD-10), and/or claim logic via automated processes.
How current is this information?
The oldest review date among the policies on this page is June 2, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under UnitedHealthcare: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: Aetna, Centene, Cigna, Humana, Alabama Medicaid, Arkansas Medicaid, BCBS Alabama, BCBS Arizona

All insurance plans · All medications

Summary of UnitedHealthcare's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.