Does UnitedHealthcare cover Wegovy?

Yes. UnitedHealthcare covers Wegovy for heart disease risk reduction with prior authorization if your BMI is 27 or higher. Other policy requirements and your plan's benefits also apply.

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.

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.

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 coverage for Wegovy (Heart Disease

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)

Does UnitedHealthcare cover Wegovy for Heart Disease Risk Reduction?

Policy document

Applies to Employer and ACA Marketplace plans.

Qualification pathways

Documentation to bring

Approval and renewal

Not covered when