Does United Healthcare cover Ozempic?

In this article:

• Does United Healthcare cover Ozempic?
• How much does Ozempic cost?
• How to check whether your United Healthcare plan covers Ozempic 
• How to save on Ozempic

In this article

• Does United Healthcare cover Ozempic?
• How much does Ozempic cost?
• How to check whether your United Healthcare plan covers Ozempic 
• How to save on Ozempic

Around 12% of all Americans report having taken Ozempic (semaglutide) or another GLP-1 drug (like Wegovy). And among U.S. adults diagnosed with Type 2 diabetes, that number skyrockets to 43%, according to a 2024 KFF survey. Ozempic is a popular prescription drug right now, not just for its approved use for Type 2 diabetes, but also because of its off-label weight loss benefits. If you’re one of the many people who are curious about Ozempic, you may know that it’s not one of the cheapest medications on the market, averaging over $1,300 per month without insurance. But if you have insurance, you might pay far less.

Insurance plans will often cover Ozempic when it’s medically necessary, but it depends on your specific health insurance plan and the reason for taking it. Read on for all the important details.

Does United Healthcare cover Ozempic?

Like most insurance-related questions, it’s slightly more complicated than a simple yes or no. “Many insurance policies have insured their clients for Ozempic, especially when it has been prescribed by a doctor on the grounds of medical necessity and declared as such,” according to Dr. Michael O. McKinney, MD, a physician specializing in weight loss at Healthy Outlook. “However, the terms of this insurance coverage and any copayments or deductibles associated with it vary.”

Insurance companies typically have many different plans, each with its own formulary—also known as a prescription drug list (PDL)—and its own policies. The only way to confirm your coverage is to check your plan’s formulary. While many plans cover Ozempic, coverage depends on which tier they place it on, affecting your copay. And there may be prior authorization requirements as well.

Drug tier

Even if a health insurance plan covers Ozempic, you still might have some out-of-pocket costs. Prescription drug plans organize covered drugs into a series of tiers, which dictate how much of the cost they’ll cover. Tier 1 consists primarily of low-cost generic drugs, while the higher tiers contain brand-name drugs and specialty medications. The higher the tier, the more you’ll typically pay. Many United Healthcare (UHC) plans have three or four tiers, and most put Ozempic in tier 2 or tier 3, meaning you’ll probably still be responsible for certain copay or coinsurance costs and deductibles.

Prior authorization

On top of that, many UHC plans require prior authorization for Ozempic and other GLP-1 medications. This is how insurance companies make sure a particular drug is medically necessary for the patient before issuing coverage. The specifics depend on the plan but may require additional paperwork from the prescribing healthcare provider or a process called step therapy—trying other, often less expensive, drugs first. Some UHC plans also have quantity limits, which put a cap on how much a healthcare provider can prescribe at one time.

If you have a Medicare Part D or Medicare Advantage plan through United Healthcare, they typically operate the same way. Medicare may cover Ozempic if it is prescribed for Type 2 diabetes, but not weight loss. The same is true with Medicaid, but each state determines its own coverage policies, so it depends on where you live.  

Does United Healthcare cover Ozempic for weight loss?

It’s complicated. The Food and Drug Administration (FDA) has approved Ozempic for  Type 2 diabetes as well as to reduce the risk of major adverse cardiovascular events (such as heart attack or stroke) in adults with Type 2 diabetes and cardiovascular disease. However, one of the reasons it’s so popular is because weight loss is a side effect, which is why healthcare providers may prescribe it off-label for weight loss. 

A Gallup poll showed that around 15.5 million Americans reported using Ozempic or similar medicines to lose weight. But this has led to Ozempic shortages, directly affecting people with Type 2 diabetes who rely on the drug. 

That’s why the drug’s manufacturer, Novo Nordisk, introduced Wegovy, which includes the same active ingredient as Ozempic—semaglutide—but with different dosages and indications. According to Dr. McKinney, “Wegovy is authorized for chronic weight management only in clients with obesity or overweight with associated comorbidity, so it could likely be granted coverage of weight loss under UHC plans. However, this also depends on the type of the plan and the medical history of the patient in question.” In addition to weight management, Wegovy is also FDA approved to reduce the risk of major adverse cardiovascular events in adults with cardiovascular disease and either obesity or overweight.

UHC often only covers Wegovy if the patient:

• Is requesting treatment for weight loss or appetite suppression
• Will also implement a lifestyle modification like dietary restrictions, exercise, behavioral support, or other community programs
• Has a body mass index (BMI) at or above 30 kg/m² for adults or in the 95th percentile for pediatric patients; or has a BMI at or above 27 kg/m² with a medical condition that may affect their weight, such as Type 2 diabetes, high blood pressure, or high cholesterol 

How much does Ozempic cost?

Prescription drug coverage is so important because Ozempic isn’t exactly cheap. Ozempic’s average cost without insurance is $1,327 per 3 mL pen—a 28-day supply. Not everyone pays that exact amount, and it can vary significantly based on where you live and which pharmacy you choose.

If your United Healthcare plan covers Ozempic, you’ll probably still have to pay a copay. The United Healthcare website says its prescription copays are $15–$60 on average, but they could be higher, depending on which tier your plan assigns Ozempic. Higher tiers typically have higher copays.

How to check whether your United Healthcare plan covers Ozempic 

Navigating the complexities of health insurance plans can be confusing, but it’s much easier if you know where to look. The first step is knowing the name of your plan. If you’re unsure, you can log in to the UHC website—or, if you have an employer-sponsored plan, ask a human resources representative.

Then, you’ll need to find your plan’s prescription drug list. You can find it by logging into your patient portal or searching this page. Just click on the list for your plan and find Ozempic. 

You can also call United Healthcare directly and ask a representative. Just make sure you have your member ID card handy since they’ll likely ask for your ID number, group number, and other information.

How to save on Ozempic

There’s no guarantee that your United Healthcare plan will cover Ozempic. But even if it doesn’t, there are still some reliable ways to save money.

For example, SingleCare coupons can instantly drop Ozempic’s price by hundreds. SingleCare negotiates directly with network pharmacies to get discounts on thousands of prescription medications, including semaglutide drugs like Ozempic. It’s free to sign up, and when you present the card at a pharmacy, you could pay $756 for a month’s supply instead of $1,327, a savings of $571 per month.

Beyond that, there are various patient assistance programs, savings programs, and other methods you can use to save money on Ozempic, with or without insurance coverage.