How long does a Wegovy approval last with UnitedHealthcare?

Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months. Liver Disease (MASH) — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.

What does UnitedHealthcare require to renew Wegovy?

Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. 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. Liver Disease (MASH) — Applies to Employer and ACA Marketplace plans. 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.

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.

UnitedHealthcare

Does UnitedHealthcare cover Wegovy?

It depends on your benefits. UnitedHealthcare covers Wegovy for weight loss only when your plan includes that benefit and the policy requirements are met.

Policy document

PA Non Formulary Wegovy

UnitedHealthcare · PA policy · Employer and ACA Marketplace

Verified June 2, 2026.

View PDF Download Original insurer source

Employer and 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 ava...

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

Full requirements: Wegovy for Weight Loss (2 plan types)

Applies to Employer and ACA Marketplace plans.

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).

See the original policy for clinical requirements.

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

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Full requirements: Wegovy for Heart Disease Risk Reduction (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

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
Renewal: 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 · View policy document (PDF)

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Full requirements: Wegovy for Liver Disease (MASH) (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

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
Renewal: 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 · View policy document (PDF)

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If weight loss isn't covered on your plan

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

Heart Disease Risk Reduction — covered on Employer and ACA Marketplace.
Liver Disease (MASH) — covered on Employer and ACA Marketplace.

Questions people ask

Does UnitedHealthcare cover Wegovy?: It depends on your benefits. UnitedHealthcare covers Wegovy for weight loss only when your plan includes that benefit and the policy requirements are met.
How long does a Wegovy approval last with UnitedHealthcare?: Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months. Liver Disease (MASH) — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does UnitedHealthcare require to renew Wegovy?: Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. 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. Liver Disease (MASH) — Applies to Employer and ACA Marketplace plans. 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.
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, Ozempic, Zepbound

Wegovy under other plans: Aetna, Centene, Cigna, Medicare GLP-1 Bridge (CMS), Alabama Medicaid, BCBS Alabama, BCBS Arizona, BCBS Arkansas

All insurance plans · All medications

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