{"id":5275,"date":"2024-10-30T20:31:30","date_gmt":"2024-12-10T03:46:30","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/?p=5275"},"modified":"2024-12-10T03:46:30","modified_gmt":"2024-12-10T03:46:30","slug":"hmn-does-united-healthcare-cover-wegovy-for-weight-loss-in-2025","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-does-united-healthcare-cover-wegovy-for-weight-loss-in-2025\/","title":{"rendered":"HMN: Does United Healthcare cover Wegovy for weight loss in 2025?"},"content":{"rendered":"<p>\n<br \/>Do you know:  Does United Healthcare cover Wegovy for weight loss? in 2025<\/p>\n<p>\n                                    United Healthcare has specific criteria for Wegovy coverage, which varies by plan                                <\/p>\n<div id=\"main-content\">\n<div id=\"post-intro\">\n<div id=\"takeaways\">\n<h2>Key takeaways<\/h2>\n<ul>\n<li>\n<p><span style=\"font-weight: 400;\">United Healthcare coverage for Wegovy varies by plan.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">Without health insurance, Wegovy typically costs $1,814.48 for a one-month supply.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">Patients need a BMI of 30 or greater <\/span><b>or<\/b><span style=\"font-weight: 400;\"> a BMI of 27 or more alongside a weight-related health condition such as diabetes, high blood pressure, or sleep apnea in order to be eligible for Wegovy coverage.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<section class=\"table-of-contents\">\n<div class=\"anchorLinks\">\n<div class=\"mobile-only\">\n<div class=\"dropdownLists\">\n<div class=\"dropdownBtn\"><span class=\"listsIcon\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/union.svg\" width=\"14\" height=\"20\"\/><\/span><br \/>\n\t\t\t\t\t\t\t<label><\/label><br \/>\n\t\t\t\t\t\t\t<span class=\"downArrow\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/dropDownArrow.svg\" width=\"24\" height=\"24\"\/><br \/>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<p><span style=\"font-weight: 400;\">Wegovy<\/span><span style=\"font-weight: 400;\"> is an injectable prescription medication <\/span><a href=\"https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2022\/215256s005lbl.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">approved by the Food and Drug Administration (FDA)<\/span><\/a><span style=\"font-weight: 400;\"> for treating obesity. It is intended to be taken weekly in conjunction with diet and exercise to help people lose weight. Its active ingredient, semaglutide, is a glucagon-like peptide-1 (GLP-1) agonist. People see as high as 14.9% total body weight loss with Wegovy, according to clinical trials published in the <\/span><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2032183\" target=\"_blank\" rel=\"noopener\"><i><span style=\"font-weight: 400;\">New England Journal of Medicine<\/span><\/i><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span data-sheets-root=\"1\" data-sheets-value=\"{\" data-sheets-userformat=\"{\" data-sheets-formula=\"=CONCATENATE(R[0]C[-2],R[0]C[-3],R[0]C[-1])\"><\/p>\n<section class=\"compass-ads-new\" data-compass-id=\"628437\">\n<aside class=\"top-section no-isi\">\n<figure class=\"col-1\">\n<div class=\"banner-heading\">\n<p><h3>\n\t\t\t\t\t\t\tPrescription Weight Loss Program\t\t\t\t\t\t<\/h3>\n<\/p><\/div>\n<\/figure>\n<figure class=\"col-2\">\n<\/figure>\n<figure class=\"col-3 no-supplimental-links-alt-layout no-client-approval-code\">\n<\/figure>\n<\/aside>\n<\/section>\n<p><\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some United Healthcare (UHC) plans cover Wegovy for weight loss, but coverage varies by plan. We\u2019ll outline UHC\u2019s Wegovy coverage criteria and explain how to save with Wegovy coupons and discounts.<\/span><\/p>\n<h2 id=\"wegovy-for-weight-loss-will-uhc-cover-it\"><b>Wegovy for weight loss: Will UHC cover it?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">It depends on the plan. For United Healthcare plans that cover Wegovy, the following standards apply. Note that state mandates and federal regulatory requirements may also impact coverage criteria.<\/span><\/p>\n<h3 id=\"uhc-wegovy-initial-authorization\"><b>UHC Wegovy initial authorization<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">On participating UHC plans, patients ages 12 and older may qualify for a four-month Wegovy prescription if they meet <\/span><a href=\"https:\/\/www.uhcprovider.com\/content\/dam\/provider\/docs\/public\/prior-auth\/drugs-pharmacy\/commercial\/r-z\/PA-Notification-Weight-Loss.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">UHC\u2019s criteria for Wegovy coverage<\/span><\/a><span style=\"font-weight: 400;\">:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The patient is requesting treatment for appetite suppression or weight loss treatment.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The patient will use Wegovy alongside lifestyle modification (e.g., dietary or caloric restriction, exercise, behavioral support, and community-based programs).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The patient has a body mass index (BMI) at or above 30 kg\/m\u00b2 for adults or in the 95th percentile for pediatric patients.\u00a0<\/span><\/li>\n<\/ul>\n<p><b>OR<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The patient has a BMI at or above 27 kg\/m\u00b2 with a weight-related medical condition such as high blood pressure, sleep apnea, or type 2 diabetes.<\/span><\/li>\n<\/ul>\n<h3 id=\"uhc-wegovy-reauthorization\"><b>UHC Wegovy reauthorization<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">For participating plans, UHC members can request coverage for an additional 12 months of a Wegovy prescription if:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The person taking Wegovy has lost at least 5% of their baseline body weight, and<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">They are continuing to make lifestyle modifications.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\t\t<\/p>\n<div class=\"singlecare-dynamic-newsletter-wrapper sin-newsletter-wrapper\">\n\t\t\t<span class=\"heading\">Get our weight management newsletter<\/span><\/p><\/div>\n<p>\t<\/span><\/p>\n<h2 id=\"how-much-does-wegovy-cost\"><b>How much does Wegovy cost?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Without health insurance, the typical cash price of Wegovy is approximately $1,833 for a 30-day supply (four injector pens), although that cost varies by pharmacy and doesn\u2019t include any discounts. Since the cost varies by pharmacy, one pharmacy may charge hundreds more than another.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Even with insurance, Wegovy\u2019s cost and coverage vary by insurance plan\u2014contact your insurance provider for details. If your United Healthcare plan doesn\u2019t cover Wegovy, consider using a  coupon card to make it more affordable. You can compare Wegovy pharmacy costs <\/span><span style=\"font-weight: 400;\">here<\/span><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h2 id=\"how-to-check-whether-your-united-healthcare-plan-covers-wegovy-for-weight-loss\"><b>How to check whether your United Healthcare plan covers Wegovy for weight loss<\/b><\/h2>\n<p><a href=\"https:\/\/www.uhc.com\/member-resources\/pharmacy-benefits\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Find your UHC coverage details<\/span><\/a><span style=\"font-weight: 400;\"> by logging in to your UHC health plan account online. Under your pharmacy and prescription coverage information, you\u2019ll find your plan\u2019s <\/span><a href=\"https:\/\/www.uhc.com\/member-resources\/pharmacy-benefits\/prescription-drug-lists\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">prescription drug list (PDL)<\/span><\/a><span style=\"font-weight: 400;\">, where you can search for Wegovy.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Another way to verify coverage is by using the Novo Nordisk <\/span><a href=\"https:\/\/www.wegovy.com\/coverage-and-savings\/check-your-cost-and-coverage.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">costs and coverage tool<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You can also call the <\/span><a href=\"https:\/\/www.uhc.com\/contact-us\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">UHC member services<\/span><\/a><span style=\"font-weight: 400;\"> number on the back of your insurance card to verify your specific insurance policy coverage. Novo Nordisk shares <\/span><a href=\"https:\/\/www.novocare.com\/content\/dam\/novonordisk\/novocare\/forms\/Wegovy_Insurance_Coverage_Guide.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">questions to ask your insurance company<\/span><\/a><span style=\"font-weight: 400;\">, such as:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">What will my copay be?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Once I meet my deductible and out-of-pocket expenses, how much will my Wegovy copay be?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are there other ways to save? For example, would a 90-day prescription cost less?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are there any steps my healthcare provider or I should take, such as prior authorization?<\/span><\/li>\n<\/ul>\n<p><b>Wegovy prior authorization<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Prior authorization is an important topic to discuss with your insurance company. \u201cInsurance plans have different requirements for weight loss medications,\u201d explains <\/span><a href=\"https:\/\/www.linkedin.com\/in\/pgxpharmacist\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Christie Kunde, Pharm.D.<\/span><\/a><span style=\"font-weight: 400;\">, owner of InformedRx. \u201cSome may cover Wegovy with no restrictions, while others may need prior authorization. Prior authorization criteria can vary, from having the right diagnosis to trying other medications first.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For those looking to streamline prior authorization for Wegovy, <\/span><a href=\"https:\/\/www.linkedin.com\/in\/suneye-koohsari-8b9796196\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Suneye Koohsari, MD<\/span><\/a><span style=\"font-weight: 400;\">, owner of Manhattan Medical Weight Loss, recommends assembling a history of your chronic weight management efforts and sharing them with your healthcare provider. You can include efforts such as:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prior diets, medications, or weight loss programs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Start and end dates for each program or medication<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Effectiveness, side effects, and reasons for discontinuation of previous treatments<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u201cThis information will be invaluable for your medical team in expediting the prior authorization process,\u201d Koohsari says.\u00a0<\/span><\/p>\n<h2 id=\"how-to-save-on-wegovy\"><b>How to save on Wegovy<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">There are other <\/span><span style=\"font-weight: 400;\">ways to save on Wegovy<\/span><span style=\"font-weight: 400;\"> if your UHC plan doesn\u2019t cover it.\u00a0<\/span><\/p>\n<h3 id=\"free-wegovy-coupons\"><span style=\"font-weight: 400;\">Free Wegovy coupons<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">A  Wegovy coupon card offers sizable savings. Depending on the pharmacy, you can save nearly $600 per month. All you need to qualify for the coupon is a valid Wegovy prescription and citizenship in the United States or Puerto Rico.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Find your free <\/span><span style=\"font-weight: 400;\"> Wegovy coupon card here<\/span><span style=\"font-weight: 400;\">, then:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Type in your zip code.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Customize dosage and quantity.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Choose your preferred pharmacy.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Click \u201cGet free coupon.\u201d\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Click \u201cSave coupon\u201d or enter your email or phone number.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Show your pharmacist the coupon during checkout.\u00a0<\/span><\/li>\n<\/ol>\n<h3 id=\"wegovy-manufacturer-savings-card\"><span style=\"font-weight: 400;\">Wegovy manufacturer savings card<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Novo Nordisk offers support and discounts through NovoCare. With <\/span><a href=\"https:\/\/www.novocare.com\/obesity\/products\/wegovy\/savings-offer.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">NovoCare\u2019s Wegovy Savings Offer<\/span><\/a><span style=\"font-weight: 400;\">, you may get a 28-day Wegovy supply for as low as a $0 copay. You can save up to $225 when using this discount card with insurance and up to $500 without insurance.\u00a0<\/span><\/p>\n<h3 id=\"wegovy-insurance-coverage\"><span style=\"font-weight: 400;\">Wegovy insurance coverage<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The Wegovy website offers <\/span><a href=\"https:\/\/www.wegovy.com\/coverage-and-savings\/wegovy-coverage-options.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">tips for gaining Wegovy insurance coverage<\/span><\/a><span style=\"font-weight: 400;\">. There\u2019s also a <\/span><a href=\"https:\/\/www.wegovy.com\/content\/dam\/obesity\/wegovy\/images\/pdf\/Wegovy_Patient_Coverage_Request_Sample_Letter.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">sample Wegovy coverage request letter<\/span><\/a><span style=\"font-weight: 400;\"> for those with private or employer-sponsored insurance.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">NovoCare recommends asking these questions to an insurance company that does not cover Wegovy:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are there any other options to get Wegovy covered by insurance? If so, what steps are required?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are exceptions or appeals accepted? If so, what steps are required?<\/span><\/li>\n<\/ul>\n<h3 id=\"wegovy-alternatives\"><b>Wegovy alternatives<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">If your UHC plan doesn\u2019t cover Wegovy, there are other options for weight loss. Some medications have weight loss as a side effect but are approved for other conditions. For example, <\/span><span style=\"font-weight: 400;\">Mounjaro<\/span><span style=\"font-weight: 400;\"> is approved to treat Type 2 diabetes, but it also reduces appetite. Without a weight-related condition, you may not be eligible for insurance coverage, but your healthcare provider may be able to prescribe it <\/span><span style=\"font-weight: 400;\">off-label<\/span><span style=\"font-weight: 400;\">. Talk to your healthcare provider about your options.<\/span><\/p>\n<p><b> <\/b><b>Wegovy vs. phentermine: Differences, similarities &amp; side effects<\/b><\/p>\n<p><span style=\"font-weight: 400;\">For added support, UHC offers <\/span><a href=\"https:\/\/realappeal.com\/member\/?utm_source=UHC&amp;utm_medium=Referral&amp;utm_campaign=RA-Acq-SPM&amp;utm_content=RA-Acq-SPM-uhc-lp\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Real Appeal<\/span><\/a><span style=\"font-weight: 400;\">, a healthy lifestyle and weight management program. Real Appeal is free through participating UHC insurance plans and provides online coaching, on-demand workouts, and science-backed health resources. Call the number on the back of your UHC membership card to see if your plan is eligible for Real Appeal benefits.<\/span><\/p>\n<p><svg style=\"display:none\">\n  <g id=\"facebook\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M19.51 9.32003H21.39V6.14003C20.4798 6.04538 19.5652 5.99865 18.65 6.00003C15.93 6.00003 14.07 7.66003 14.07 10.7V13.32H11V16.88H14.07V26H17.75V16.88H20.81L21.27 13.32H17.75V11.05C17.75 10 18.03 9.32003 19.51 9.32003Z\"\/>\n  <\/g>\n  <g id=\"twitter\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M26 9.9506C25.2483 10.2767 24.4534 10.4923 23.64 10.5906C24.4982 10.0779 25.1413 9.27138 25.45 8.3206C24.6436 8.80066 23.7608 9.1389 22.84 9.3206C22.2245 8.65317 21.405 8.2089 20.5098 8.05745C19.6147 7.90601 18.6945 8.05596 17.8938 8.48379C17.093 8.91162 16.4569 9.59313 16.0852 10.4214C15.7135 11.2497 15.6273 12.178 15.84 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                       <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Do you know: Does United Healthcare cover Wegovy for weight loss? in 2025 United Healthcare has specific criteria for Wegovy coverage, which varies by plan Key takeaways United Healthcare coverage for Wegovy varies by plan. Without health insurance, Wegovy typically costs $1,814.48 for a one-month supply. Patients need a BMI of 30 or greater or [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5275","post","type-post","status-publish","format-standard","hentry","category-health-news"],"blocksy_meta":[],"_links":{"self":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/5275","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/comments?post=5275"}],"version-history":[{"count":1,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/5275\/revisions"}],"predecessor-version":[{"id":5813,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/5275\/revisions\/5813"}],"wp:attachment":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/media?parent=5275"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/categories?post=5275"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/tags?post=5275"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}