UnitedHealthcare

Does UnitedHealthcare cover Wegovy?

Quick answer · Weight Loss

UnitedHealthcare covers it only when the plan's benefit includes it on Employer / Commercial Insurance and ACA Marketplace.

  • Employer / Commercial Insurance: Depends on your plan's benefit. This is an optional program for clients/businesses that have elected to cover weight loss products. Not available on plans without weight loss medication coverage (those plans use a separate Nonformulary Wegovy criteria policy).
  • ACA Marketplace: Depends on your plan's benefit. This is an optional program for clients/businesses that have elected to cover weight loss products. Not available on plans without weight loss medication coverage (those plans use a separate Nonformulary Wegovy criteria policy).

Last verified June 2, 2026. Policy effective May 1, 2026. Source: PA-Notification-Weight-Loss.pdf and PA-Non-Formulary-Wegovy.pdf. How we verify this data →

Check your card for your exact plan →

Wegovy for Weight Loss

What UnitedHealthcare requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Depends on your plan's benefit

This is an optional program for clients/businesses that have elected to cover weight loss products. Not available on plans without weight loss medication coverage (those plans use a separate Nonformulary Wegovy criteria policy).

No additional clinical requirements are listed beyond the diagnosis.

Policy note: Weight loss is explicitly excluded as a benefit under this program. This policy document only establishes criteria for cardiovascular risk reduction and MASH indications.

Policy effective May 1, 2026 · verified June 2, 2026 · source: PA-Notification-Weight-Loss.pdf

ACA Marketplace

Depends on your plan's benefit

This is an optional program for clients/businesses that have elected to cover weight loss products. Not available on plans without weight loss medication coverage (those plans use a separate Nonformulary Wegovy criteria policy).

No additional clinical requirements are listed beyond the diagnosis.

Policy note: Weight loss is explicitly excluded as a benefit under this program. This policy document only establishes criteria for cardiovascular risk reduction and MASH indications.

Policy effective May 1, 2026 · verified June 2, 2026 · source: PA-Notification-Weight-Loss.pdf

Wegovy for Heart Disease Risk Reduction

What UnitedHealthcare requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Age 45 and older
  • BMI of 27 or higher
  • A1C no higher than 6.5%
  • Established cardiovascular disease (MI, ischemic_stroke, hemorrhagic_stroke, and PAD)
  • On guideline-directed medical therapy (statin, PCSK9i, beta_blocker, ACE_inhibitor, ARB, ARNI, and antiplatelet)
  • Lab results confirming eligibility
  • Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction — History of MI

All of:

  • Treatment requested to reduce risk of major adverse cardiovascular events
  • Patient age >= 45 years
  • BMI >= 27 kg/m2 (documented in medical records)
  • Prior myocardial infarction (MI) documented in medical records
  • Used in combination with reduced calorie diet and increased physical activity
  • No diagnosis of diabetes and HgA1c <= 6.5%
  • No New York Heart Association class IV heart failure
  • On cholesterol-lowering medication (statin or PCSK9i) unless contraindicated or intolerant
  • On beta-blocker (carvedilol, metoprolol, or bisoprolol) unless contraindicated or intolerant
  • On ACE-I, ARB, or ARNI unless contraindicated or intolerant
  • On antiplatelet therapy (aspirin or clopidogrel) unless contraindicated or intolerant

CV Risk Reduction — History of Ischemic or Hemorrhagic Stroke

All of:

  • Treatment requested to reduce risk of major adverse cardiovascular events
  • Patient age >= 45 years
  • BMI >= 27 kg/m2 (documented in medical records)
  • Prior ischemic or hemorrhagic stroke documented in medical records
  • Used in combination with reduced calorie diet and increased physical activity
  • No diagnosis of diabetes and HgA1c <= 6.5%
  • No New York Heart Association class IV heart failure
  • On cholesterol-lowering medication (statin or PCSK9i) unless contraindicated or intolerant
  • On ACE-I, ARB, or ARNI unless contraindicated or intolerant
  • On antiplatelet therapy (aspirin or clopidogrel) unless contraindicated or intolerant

CV Risk Reduction — Symptomatic Peripheral Arterial Disease (PAD)

All of:

  • Treatment requested to reduce risk of major adverse cardiovascular events
  • Patient age >= 45 years
  • BMI >= 27 kg/m2 (documented in medical records)
  • Used in combination with reduced calorie diet and increased physical activity
  • No diagnosis of diabetes and HgA1c <= 6.5%
  • No New York Heart Association class IV heart failure
  • On cholesterol-lowering medication (statin or PCSK9i) unless contraindicated or intolerant
  • On ACE-I, ARB, or ARNI unless contraindicated or intolerant
  • On antiplatelet therapy (aspirin or clopidogrel) unless contraindicated or intolerant

Plus any one of:

  • Intermittent claudication with ankle-brachial index (ABI) < 0.85 at rest
  • Peripheral arterial revascularization procedure
  • Amputation due to atherosclerotic disease

Documentation to bring

  • Medical records documenting BMI >= 27 kg/m2
  • Medical records documenting established cardiovascular disease (prior MI, prior ischemic or hemorrhagic stroke, or symptomatic PAD with qualifying evidence)
  • For PAD: ABI < 0.85 at rest, peripheral arterial revascularization procedure record, or amputation due to atherosclerotic disease
  • Documentation of current use of required GDMT medications (cholesterol-lowering, beta-blocker [for MI], ACE-I/ARB/ARNI, antiplatelet) or clinical reason for contraindication/intolerance for each class
  • HgA1c result confirming <= 6.5% and no diabetes diagnosis
  • Confirmation of absence of NYHA Class IV heart failure

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Reauthorization requires: (1) continued use with reduced calorie diet and increased physical activity, AND (2) absence of diabetes diagnosis or HgA1c > 6.5%, AND absence of NYHA Class IV heart failure. BMI requirement is NOT re-checked at reauthorization (removed in 2/2026 update). GDMT requirement is NOT re-checked at reauthorization. Age requirement is NOT re-checked at reauthorization.

Not covered when

  • Diagnosis of diabetes or HgA1c > 6.5%
  • New York Heart Association (NYHA) Class IV heart failure

Policy note: Both Wegovy injection and Wegovy tablets are covered for this indication. Reauthorization criteria do NOT re-check BMI, age, GDMT use, or documented CV event — only ongoing absence of diabetes/high A1C, absence of NYHA Class IV heart failure, and continued diet/exercise are required at renewal. Beta-blocker requirement (carvedilol, metoprolol, or bisoprolol) applies only to patients with history of MI, not stroke or PAD.

Policy effective May 1, 2026 · verified June 2, 2026 · source: PA-Non-Formulary-Wegovy.pdf

ACA Marketplace

Covered with requirements

What you need to qualify

  • Age 45 and older
  • BMI of 27 or higher
  • A1C no higher than 6.5%
  • Established cardiovascular disease (MI, ischemic_stroke, hemorrhagic_stroke, and PAD)
  • On guideline-directed medical therapy (statin, PCSK9i, beta_blocker, ACE_inhibitor, ARB, ARNI, and antiplatelet)
  • Lab results confirming eligibility
  • Not being used to treat type 1 diabetes

Qualification pathways

You can qualify through any one of these.

CV Risk Reduction — History of MI

All of:

  • Treatment requested to reduce risk of major adverse cardiovascular events
  • Patient age >= 45 years
  • BMI >= 27 kg/m2 (documented in medical records)
  • Prior myocardial infarction (MI) documented in medical records
  • Used in combination with reduced calorie diet and increased physical activity
  • No diagnosis of diabetes and HgA1c <= 6.5%
  • No New York Heart Association class IV heart failure
  • On cholesterol-lowering medication (statin or PCSK9i) unless contraindicated or intolerant
  • On beta-blocker (carvedilol, metoprolol, or bisoprolol) unless contraindicated or intolerant
  • On ACE-I, ARB, or ARNI unless contraindicated or intolerant
  • On antiplatelet therapy (aspirin or clopidogrel) unless contraindicated or intolerant

CV Risk Reduction — History of Ischemic or Hemorrhagic Stroke

All of:

  • Treatment requested to reduce risk of major adverse cardiovascular events
  • Patient age >= 45 years
  • BMI >= 27 kg/m2 (documented in medical records)
  • Prior ischemic or hemorrhagic stroke documented in medical records
  • Used in combination with reduced calorie diet and increased physical activity
  • No diagnosis of diabetes and HgA1c <= 6.5%
  • No New York Heart Association class IV heart failure
  • On cholesterol-lowering medication (statin or PCSK9i) unless contraindicated or intolerant
  • On ACE-I, ARB, or ARNI unless contraindicated or intolerant
  • On antiplatelet therapy (aspirin or clopidogrel) unless contraindicated or intolerant

CV Risk Reduction — Symptomatic Peripheral Arterial Disease (PAD)

All of:

  • Treatment requested to reduce risk of major adverse cardiovascular events
  • Patient age >= 45 years
  • BMI >= 27 kg/m2 (documented in medical records)
  • Used in combination with reduced calorie diet and increased physical activity
  • No diagnosis of diabetes and HgA1c <= 6.5%
  • No New York Heart Association class IV heart failure
  • On cholesterol-lowering medication (statin or PCSK9i) unless contraindicated or intolerant
  • On ACE-I, ARB, or ARNI unless contraindicated or intolerant
  • On antiplatelet therapy (aspirin or clopidogrel) unless contraindicated or intolerant

Plus any one of:

  • Intermittent claudication with ankle-brachial index (ABI) < 0.85 at rest
  • Peripheral arterial revascularization procedure
  • Amputation due to atherosclerotic disease

Documentation to bring

  • Medical records documenting BMI >= 27 kg/m2
  • Medical records documenting established cardiovascular disease (prior MI, prior ischemic or hemorrhagic stroke, or symptomatic PAD with qualifying evidence)
  • For PAD: ABI < 0.85 at rest, peripheral arterial revascularization procedure record, or amputation due to atherosclerotic disease
  • Documentation of current use of required GDMT medications (cholesterol-lowering, beta-blocker [for MI], ACE-I/ARB/ARNI, antiplatelet) or clinical reason for contraindication/intolerance for each class
  • HgA1c result confirming <= 6.5% and no diabetes diagnosis
  • Confirmation of absence of NYHA Class IV heart failure

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Reauthorization requires: (1) continued use with reduced calorie diet and increased physical activity, AND (2) absence of diabetes diagnosis or HgA1c > 6.5%, AND absence of NYHA Class IV heart failure. BMI requirement is NOT re-checked at reauthorization (removed in 2/2026 update). GDMT requirement is NOT re-checked at reauthorization. Age requirement is NOT re-checked at reauthorization.

Not covered when

  • Diagnosis of diabetes or HgA1c > 6.5%
  • New York Heart Association (NYHA) Class IV heart failure

Policy note: Both Wegovy injection and Wegovy tablets are covered for this indication. Reauthorization criteria do NOT re-check BMI, age, GDMT use, or documented CV event — only ongoing absence of diabetes/high A1C, absence of NYHA Class IV heart failure, and continued diet/exercise are required at renewal. Beta-blocker requirement (carvedilol, metoprolol, or bisoprolol) applies only to patients with history of MI, not stroke or PAD.

Policy effective May 1, 2026 · verified June 2, 2026 · source: PA-Non-Formulary-Wegovy.pdf

Wegovy for Liver Disease (MASH)

What UnitedHealthcare requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Prescribed by or in consultation with a specialist
  • Confirmed MASH diagnosis by FibroScan_VCTE, MRE, and liver_biopsy, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

MASH Initial Authorization

All of:

  • Wegovy injection requested for treatment of MASH (formerly NASH)
  • Disease confirmed as fibrosis stage F2 or F3 by qualifying diagnostic method
  • Used in combination with reduced calorie diet and increased physical activity
  • Provider attests Wegovy injection will not be initiated simultaneously with Rezdiffra (resmetirom) for the same indication
  • Prescribed by or in consultation with gastroenterologist or hepatologist

Plus any one of:

  • Liver stiffness measurement by VCTE (e.g., FibroScan)
  • Liver stiffness measurement by MRE
  • Liver biopsy within the past 12 months

MASH Reauthorization

All of:

  • Documentation of positive clinical response to Wegovy injection (e.g., improvement in or stabilization of fibrosis)
  • Patient has not progressed to cirrhosis
  • Used in combination with reduced calorie diet and increased physical activity
  • Prescribed by or in consultation with gastroenterologist or hepatologist

Documentation to bring

  • Medical records documenting MASH diagnosis (formerly NASH)
  • Documentation of fibrosis stage F2 or F3 confirmed by one of: liver stiffness measurement via VCTE (e.g., FibroScan), liver stiffness measurement via MRE, or liver biopsy within the past 12 months
  • Provider attestation that Wegovy injection will not be initiated simultaneously with Rezdiffra (resmetirom) for treatment of MASH
  • Documentation that treatment is prescribed by or in consultation with a gastroenterologist or hepatologist

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Reauthorization requires: (1) documentation of positive clinical response (e.g., improvement in or stabilization of fibrosis), AND (2) patient has not progressed to cirrhosis, AND (3) continued use with reduced calorie diet and increased physical activity, AND (4) continued prescribing by or in consultation with gastroenterologist or hepatologist. Fibrosis stage confirmation (imaging/biopsy) is NOT re-checked at reauthorization.

Not covered when

  • Cirrhosis (noncirrhotic MASH only; patients who progress to cirrhosis are excluded at reauthorization)
  • Concurrent initiation of Rezdiffra (resmetirom) for MASH

Policy note: Only Wegovy injection (not tablets) is covered for MASH. Imaging lookback period is not specified for VCTE/MRE — only liver biopsy has an explicit 12-month lookback. The policy covers moderate to advanced fibrosis (F2-F3) consistent with FDA labeling. Added to program in November 2025.

Policy effective May 1, 2026 · verified June 2, 2026 · source: PA-Non-Formulary-Wegovy.pdf

ACA Marketplace

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Prescribed by or in consultation with a specialist
  • Confirmed MASH diagnosis by FibroScan_VCTE, MRE, and liver_biopsy, fibrosis stage F2 to F3

Qualification pathways

You can qualify through any one of these.

MASH Initial Authorization

All of:

  • Wegovy injection requested for treatment of MASH (formerly NASH)
  • Disease confirmed as fibrosis stage F2 or F3 by qualifying diagnostic method
  • Used in combination with reduced calorie diet and increased physical activity
  • Provider attests Wegovy injection will not be initiated simultaneously with Rezdiffra (resmetirom) for the same indication
  • Prescribed by or in consultation with gastroenterologist or hepatologist

Plus any one of:

  • Liver stiffness measurement by VCTE (e.g., FibroScan)
  • Liver stiffness measurement by MRE
  • Liver biopsy within the past 12 months

MASH Reauthorization

All of:

  • Documentation of positive clinical response to Wegovy injection (e.g., improvement in or stabilization of fibrosis)
  • Patient has not progressed to cirrhosis
  • Used in combination with reduced calorie diet and increased physical activity
  • Prescribed by or in consultation with gastroenterologist or hepatologist

Documentation to bring

  • Medical records documenting MASH diagnosis (formerly NASH)
  • Documentation of fibrosis stage F2 or F3 confirmed by one of: liver stiffness measurement via VCTE (e.g., FibroScan), liver stiffness measurement via MRE, or liver biopsy within the past 12 months
  • Provider attestation that Wegovy injection will not be initiated simultaneously with Rezdiffra (resmetirom) for treatment of MASH
  • Documentation that treatment is prescribed by or in consultation with a gastroenterologist or hepatologist

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for Reauthorization requires: (1) documentation of positive clinical response (e.g., improvement in or stabilization of fibrosis), AND (2) patient has not progressed to cirrhosis, AND (3) continued use with reduced calorie diet and increased physical activity, AND (4) continued prescribing by or in consultation with gastroenterologist or hepatologist. Fibrosis stage confirmation (imaging/biopsy) is NOT re-checked at reauthorization.

Not covered when

  • Cirrhosis (noncirrhotic MASH only; patients who progress to cirrhosis are excluded at reauthorization)
  • Concurrent initiation of Rezdiffra (resmetirom) for MASH

Policy note: Only Wegovy injection (not tablets) is covered for MASH. Imaging lookback period is not specified for VCTE/MRE — only liver biopsy has an explicit 12-month lookback. The policy covers moderate to advanced fibrosis (F2-F3) consistent with FDA labeling. Added to program in November 2025.

Policy effective May 1, 2026 · verified June 2, 2026 · source: PA-Non-Formulary-Wegovy.pdf

Why Wegovy requests get denied by UnitedHealthcare

Based on what this policy asks for. Fix these before the first submission.

  1. Your specific plan doesn't include the weight loss benefit. Coverage here is conditional on the benefit design (often an optional employer add-on), so confirm it before submitting.
  2. Wrong brand for the diagnosis. Wegovy and Ozempic are the same molecule with different approved uses; a request for Wegovy under a diagnosis that matches Ozempic is routinely denied.
  3. BMI not documented in the chart notes (or documented without a baseline weight and date).
  4. Prescriber isn't the specialist the plan requires.

If weight loss isn't covered on your plan

UnitedHealthcare has separate Wegovy policies that don't depend on the weight loss benefit:

Wegovy is also sold directly by Novo Nordisk without insurance through NovoCare.

Frequently asked questions

Does UnitedHealthcare cover Wegovy?
UnitedHealthcare covers it only when the plan's benefit includes it on Employer / Commercial Insurance and ACA Marketplace.
How long does a Wegovy approval last with UnitedHealthcare?
Initial approvals last 12 months, and renewals are granted in 12-month periods.
What does UnitedHealthcare require to renew Wegovy?
Reauthorization requires: (1) continued use with reduced calorie diet and increased physical activity, AND (2) absence of diabetes diagnosis or HgA1c > 6.5%, AND absence of NYHA Class IV heart failure. BMI requirement is NOT re-checked at reauthorization (removed in 2/2026 update). GDMT requirement is NOT re-checked at reauthorization. Age requirement is NOT re-checked at reauthorization.
What if my plan excludes weight loss medications?
UnitedHealthcare has separate Wegovy policies for heart disease risk reduction and liver disease (mash), which are covered on some plan types and don't depend on the weight-loss benefit. Wegovy is also available for cash through NovoCare.
How current is this information?
This page reflects UnitedHealthcare's written policy as of May 1, 2026, last verified against the source document on June 2, 2026.

Other medications under UnitedHealthcare

Wegovy coverage under other plans

All insurance plans · All medications

This page summarizes UnitedHealthcare's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.