Does UnitedHealthcare Cover Ozempic? Criteria, Copay, Appeals
UnitedHealthcare covers Ozempic for type 2 diabetes on its drug list, usually with prior authorization. Ozempic is approved for type 2 diabetes, and kidney disease and heart risk in people who have type 2 diabetes, not weight loss, so the plan judges it on those uses.
- For type 2 diabetes
- Covered on formulary
- Prior authorization
- Required
- For weight loss
- Plan dependent
- Self-pay if denied
- $149 a month
Ozempic in brief
Its half-life is about 1 week. After 7 d, half is gone; about 3% remains after five half-lives (35 d).
In SUSTAIN 1 over 30 weeks, people with type 2 diabetes lost 4.7 kg, against 1.2 kg on placebo.
List price and self-pay offers appear in monthly figures in US dollars. The maker's price page supplies each figure.
Sources: FDA label (DailyMed), healthsystemtracker.org, prnewswire.com 1 2.
Does UnitedHealthcare cover Ozempic?
| Medicine | Approved for | Status | Prior authorization |
|---|---|---|---|
| Ozempic | Type 2 diabetes, and kidney disease and heart risk in people who have type 2 diabetes | Covered on formulary | Required |
Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.
The published policy
The commercial insurer is UnitedHealthcare
- Program number: 2026 P 1114-23
- Wegovy tablets: Typically excluded
View the full policy here: uhcprovider.com
Source: uhcprovider.com.
A checklist for prior authorization
- Your chart lists either type 2 diabetes, or kidney disease together with heart risk in type 2 diabetes. The latter is another approved Ozempic use.
- Your records include recent A1C results and the diabetes medicines you have tried so far.
- Your prescriber files the prior authorization request, not you.
The appeal if you are denied
| Denial reason | What to send or ask |
|---|---|
| Prior authorization missing | Your prescriber sends the plan's form, together with recent A1C results and the type 2 diabetes diagnosis. |
| The plan wants another drug first | Provide the plan with records of drugs you have already tried. Ask which drugs it wants tried initially. |
| The drug is not on the plan's list | Ask the plan which alternative GLP-1 it prefers, and request a formulary exception. |
- Get the denial letter; it names the exact rule that was not met.
- Your prescriber files the appeal, and chart notes that answer the rule go with it.
- When the plan's appeal does not succeed, ask an independent reviewer for an external review.
State and plan variation
| Plan | For type 2 diabetes | Prior authorization |
|---|---|---|
| Medicare | Covered by Part D plans | Required |
| Medicaid | Covered | Required |
 Aetna | Covered on formulary | Required |
 Cigna (Evernorth / Express Scripts) | Covered on formulary | Required |
 Blue Cross Blue Shield | Covered on formulary | Required |
 Kaiser Permanente | Covered on formulary | Required |
| TRICARE | Covered with PA | Required |
 Ambetter (Centene) | Covered on formulary | Required |
 Amerigroup (Elevance Medicaid) | Covered with PA | Required |
 CVS Caremark | Covered on formulary | Required |
| Express Scripts | Covered on formulary | Required |
| Optum Rx | Covered on formulary | Required |
 Humana | Covered by Part D plans | Required |
| VA (Veterans Health Administration) | Covered | Required |
 GEHA | Covered | Required |
| ACA Marketplace plans | Common | Required |
 Navitus | Covered on formulary | Not listed |
10 states now cover GLP-1s for weight loss. See every state
Other paths after a coverage denial
| Route | Who it is for | What you pay | Limits and dates |
|---|---|---|---|
| NovoCare Pharmacy: Ozempic pill (from 1.5 mg) | Self-pay, no insurance needed | $149 a month | Not listed |
| TrumpRx listing (pen, starting) | Self-pay only, not with insurance | $199 a month | It starts November 17, 2025 and runs to December 31, 2026 |
| Novo Nordisk PAP | Household income at or below 200% of the federal poverty level | Free if approved | 200% of the poverty level applies as the income limit. Not an option for anyone with Medicare drug coverage |
Prices checked November 2026. Every price links back to the page it came from.
Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.