Does UnitedHealthcare Cover Saxenda? Criteria, Copay, Appeals

UnitedHealthcare covers Saxenda for weight loss only when your employer or plan has added weight-loss drugs. Where it is covered, you need a BMI of 27 or more with a weight-related condition.

For weight loss: Plan dependent
For type 2 diabetes: Covered on formulary
Prior authorization: Required
Weight rule: A BMI of 27 or more with a weight-related condition

The basics on Saxenda

How long it lasts in the body

Its half-life is about 13 hours: after 13 h half is gone, and after five half-lives (2.7 d) about 3% remains.

Weight loss in its main trial

In the SCALE Obesity and Prediabetes, 56 weeks trial, weight loss was 7.4% of body weight, compared with 3% on placebo.

Sources: FDA label (DailyMed).

Does UnitedHealthcare cover Saxenda?

UnitedHealthcare and Saxenda
Medicine	Approved for	Status	Prior authorization
Saxenda	Weight loss	Plan dependent	Required

Sources: Novo Nordisk pricing, NovoCare, uhcprovider.com.

The published policy

UnitedHealthcare operates as a commercial insurer

Program number: 2026 P 1114-23
Wegovy tablets are usually excluded

Read the full policy at uhcprovider.com.

Source: uhcprovider.com.

Prior authorization checklist

Diagnosis: your chart lists the weight diagnosis the plan asks for
The lower weight threshold: BMI 27, or a higher number, plus a weight-related condition
Records: the program for diet and activity that you tried, plus your measured height, your measured weight, and your weight-related conditions.
Your prescriber sends the prior authorization request; you do not.

Source: uhcprovider.com.

After a denial: the appeal

Denial reasons and ways to fix them
Denial reason	What to send or ask
The plan excludes weight-loss drugs	This is a plan design choice. Ask your employer's benefits team whether weight-loss drugs are added to the plan at renewal.
Criteria not met	Have your prescriber resubmit the request with your measured BMI and all weight-related conditions listed in your chart. The rule requires BMI of 27 or more plus a weight-related condition.
The drug is not on the plan's list	Ask the plan which GLP-1 medication it prefers as an alternative, and request a formulary exception.

The denial letter lists the rule that was not met, so get that letter.
Chart notes that answer that rule go with the appeal your prescriber files.
Should the plan's internal appeal fail, request an independent review from outside the plan.

State and plan differences

Saxenda coverage in other plans
Plan	For weight loss	Prior authorization
Medicare	Bridge program only	Required
Medicaid	Varies by state	Required
Aetna	Employer option	Required
Cigna (Evernorth / Express Scripts)	Plan dependent	Required
Blue Cross Blue Shield	Plan dependent	Required
Kaiser Permanente	Plan dependent	Required
CVS Caremark	Plan sponsor choice	Required
Express Scripts	Plan sponsor choice	Required
Optum Rx	Plan sponsor choice	Required
Humana	Bridge program only	Required
TRICARE	Prime and Select only	Required
VA (Veterans Health Administration)	Covered with criteria	Required
GEHA	Covered with PA	Required
Ambetter (Centene)	Excluded	Required
ACA Marketplace plans	Rare	Required
Navitus	Plan sponsor choice	Not listed
Amerigroup (Elevance Medicaid)	Follows state Medicaid	Required