Does UnitedHealthcare cover Ozempic?
From published formulary and policy documents for the plan type below. Not a decision for your member ID.
Sources last checked October 24, 2026
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Covered with restrictions. Ozempic is Tier 2 with PA and a quantity limit on the 2026 Optum Rx Premium Formulary. UHC's GLP-1 diabetes PA program (P&T approved 4/2026, effective 7/1/2026) requires a documented type 2 diabetes diagnosis (A1C 6.5% or higher, fasting glucose 126 mg/dL or higher, or 2-hour OGTT 200 mg/dL or higher; or an established diagnosis over 2 years) with 12-month approvals. UHC states these drugs are not FDA approved for weight loss and weight-loss use is typically excluded.
Applies to: Commercial (employer and individual) plans on the Optum Rx Premium Formulary; type 2 diabetes indication only
Source: UnitedHealthcare Pharmacy Clinical Program: Diabetes Agents, GLP-1 Receptor Agonists (PA/Notification), P&T 4/2026; effective 2026-07-01
Policy details
Sources last checked October 11, 2026
Approval criteria
- Medical records, such as chart notes, confirming a type 2 diabetes diagnosis shown by at least one of these lab results: A1C of 6.5 percent or higher; fasting plasma glucose of 126 mg/dL or higher; 2-hour glucose of 200 mg/dL or higher on an oral glucose tolerance test; or random glucose of 200 mg/dL or higher with classic symptoms of high blood sugar or a hyperglycemic crisis.
- A separate pathway covers people who need ongoing treatment and were diagnosed more than 2 years ago.
Quantity limits
The policy says supply limits may be in place. It does not state a specific amount.
Approval length
12 months
Renewal criteria
- UnitedHealthcare may approve initial and renewal requests based on prior claim or medication history, diagnosis codes or claim logic, so a renewal does not always need new paperwork.
Exclusions and limits
- Ozempic and Mounjaro are not FDA approved for weight loss, and medications used for weight loss are typically excluded from benefit coverage.
- State mandates and the member's own benefit plan can change what is covered.
Policy
Program 2026 P 1332-8, effective 7/1/2026, annual review 4/2026
Effective July 1, 2026
What this means
The published policy lists approval criteria, a quantity limit, an initial approval of 12 months, continuation criteria, and uses that are not covered.
This reflects the insurer's published formulary and policy for the plan type above. Your employer or plan may exclude weight-loss drugs or differ. Confirm with the number on your ID card.