UnitedHealthcare · Liver Disease (MASH)

UnitedHealthcare coverage for Wegovy (Liver Disease (MASH))

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

All Wegovy policies under UnitedHealthcare · Check your card