Does UnitedHealthcare cover Wegovy?
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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Coverage varies. Wegovy is listed Tier 2 with PA, QL and the '++' flag on the 2026 Optum Rx Premium Formulary, meaning coverage depends on the member's benefit design. UHC's weight loss PA notification (August 2026, effective 10/1/2026) says weight-loss drugs are an optional program for clients that elected coverage. Wegovy criteria cover chronic weight management (age 12+; BMI 30+, or 27+ with a weight-related comorbidity, or pediatric BMI at or above the 95th percentile), plus cardiovascular risk reduction and MASH indications. Wegovy tablets are typically excluded. Reauthorization needs about 5% weight loss from baseline plus continued lifestyle modification, with initial approvals of 3 to 6 months.
Applies to: Commercial plans only where the employer or plan sponsor elected the optional weight-loss drug program; otherwise excluded (benefit design)
Source: UnitedHealthcare Pharmacy Clinical Program: Weight Loss/Appetite Suppression Medication Coverage (PA/Notification), August 2026; effective 2026-10-01
Policy details
Sources last checked October 11, 2026
Approval criteria
- Weight loss: baseline BMI of 30 or higher, or BMI of 27 or higher with a weight-related condition. The policy gives dyslipidemia, high blood pressure, type 2 diabetes and sleep apnea as examples.
- Wegovy injection: age 12 or older. Wegovy tablet and Wegovy HD: older than 16.
- Used as an add-on to lifestyle changes such as diet or calorie restriction, exercise, behavioral support or a community program.
- Wegovy is also reviewed for lowering the risk of major heart events in people with established cardiovascular disease (Wegovy injection or tablet).
- Wegovy injection is also reviewed for MASH with moderate to advanced fibrosis. No BMI requirement applies to that use.
Source: UnitedHealthcare Prior Authorization/Notification: Weight Loss/Appetite Suppression (2026 P 1114-23)
Quantity limits
The policy says supply limits may be in place. It does not state a specific amount.
Source: UnitedHealthcare Prior Authorization/Notification: Weight Loss/Appetite Suppression (2026 P 1114-23)
Approval length
5 months for Wegovy injection, Wegovy tablet and Wegovy HD
Source: UnitedHealthcare Prior Authorization/Notification: Weight Loss/Appetite Suppression (2026 P 1114-23)
Renewal criteria
- Weight loss of at least 5 percent of baseline body weight for Wegovy injection, Wegovy tablet and Wegovy HD.
- Continued lifestyle changes.
- Reauthorization is approved for 12 months.
Source: UnitedHealthcare Prior Authorization/Notification: Weight Loss/Appetite Suppression (2026 P 1114-23)
Exclusions and limits
- This program applies to employers and plans that chose to cover weight-loss drugs with prior authorization. Plans that do not cover weight-loss medications use separate criteria.
- State mandates, federal requirements and the member's own benefit plan can change what is covered.
Source: UnitedHealthcare Prior Authorization/Notification: Weight Loss/Appetite Suppression (2026 P 1114-23)
Policy
Program 2026 P 1114-23, revised 8/2026, effective 10/1/2026
Source: UnitedHealthcare Prior Authorization/Notification: Weight Loss/Appetite Suppression (2026 P 1114-23)
Effective October 1, 2026
Source: UnitedHealthcare Prior Authorization/Notification: Weight Loss/Appetite Suppression (2026 P 1114-23)
Employer plans can differ
Weight-loss coverage under this program depends on whether the employer or plan sponsor elected it.
Source: UnitedHealthcare Prior Authorization/Notification: Weight Loss/Appetite Suppression (2026 P 1114-23)
What this means
The published policy lists approval criteria, a quantity limit, an initial approval of 5 months for Wegovy injection, Wegovy tablet and Wegovy HD, 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.