Does UnitedHealthcare Cover GLP-1s? 2026 Rules by Plan and Drug

UnitedHealthcare (UHC) lists Ozempic, Mounjaro, Rybelsus and Trulicity, GLP-1 drugs for type 2 diabetes, on its employer-plan drug list and approves them with prior authorization (approval in advance) when your records show type 2 diabetes.^{1, 2} On the same list, Bydureon BCise and the 5 mcg Byetta pen need no prior authorization.^{1, 2} For weight loss, coverage depends on your plan and sometimes your state, and UHC says weight-loss drugs are excluded under most plans.^{3, 4, 5}

Find your situation:

• Type 2 diabetes. Ozempic, Mounjaro, Rybelsus and Trulicity need records showing type 2 diabetes, so UHC won't approve Ozempic or Mounjaro for weight loss alone. See UHC's diabetes rules.²
• Weight loss on a plan from work. Wegovy (semaglutide, like Ozempic), Zepbound (tirzepatide, like Mounjaro) and Foundayo (a daily pill FDA approved in 2026) are covered for weight loss only if your employer added UHC's optional weight-loss program, or where state rules require it. See how to find out.^{4, 6}
• Cardiovascular disease, MASH or obstructive sleep apnea. Separate routes for Wegovy and Zepbound can apply even when weight loss is excluded.^{7, 8, 9} MASH is a form of fatty liver disease with inflammation and liver damage that can lead to scarring.¹⁰ See the criteria.
• Individual & Family (Marketplace) plan. Weight-loss drugs are covered with prior authorization in New York and New Mexico and excluded in UHC's other states. See the Marketplace rules.^{5, 11, 12}
• UHC or AARP Medicare plan. Federal law leaves weight-loss use out of Part D's basic benefit, though a plan with enhanced coverage can add it; Medicare's separate GLP-1 Bridge covers Wegovy, Foundayo or the Zepbound KwikPen for a $50 monthly copay if you qualify. See Medicare plans and the Bridge.^{13, 14, 15, 16}
• Community Plan (Medicaid). It depends on your state. See what to check.^{17, 14}
• Turned down, or paying yourself. See what a denial means and how to appeal, or cash prices and copay cards.
• Starting one of these drugs. See what the labels warn about.

Coverage at a glance, plan by plan

This summary comes from UHC's and Medicare's own documents. Your plan's terms, and sometimes state law, decide what you actually get.^{4, 18}

A tier is a cost level. Tier numbers differ from list to list, and your employer or plan decides what each tier costs.^{3, 18}

How to check what your own plan covers

No public page can tell you exactly what your plan covers, this one included. UHC says its public drug lists are general information only. Your plan's own list sits behind your member sign-in.¹⁸

1. Look up the drug. Sign in at myuhc.com or call the member number on your ID card. Ask what tier the drug is on, whether it needs prior authorization, and what you would pay. UHC's drug list page explains the lists.^{1, 18}
2. Ask about weight-loss coverage. If you get UHC through work, ask HR or your benefits office: "Does our UHC plan cover weight-loss medicines such as Wegovy or Zepbound?" That answer usually decides whether UHC will pay for them when they're prescribed for weight loss, though UHC notes that state rules and your plan's terms can also matter.⁴ On an Individual & Family plan, it depends on your state (see Marketplace plans).
3. Match the request to your diagnosis. Your prescriber files the prior authorization, through the Optum Rx prior authorization team for UHC pharmacy benefits, under the program that fits your records: type 2 diabetes, weight management, cardiovascular disease, MASH or obstructive sleep apnea.^{1, 2, 4, 7, 8} Our prior authorization guide covers requests and appeals step by step.
4. On Medicare, check two things. Look up your plan's current drug list for the use you need. If the goal is weight management, ask your prescriber about the Bridge.^{20, 23}

Employer plans: your employer decides about weight-loss drugs

If your UHC plan comes through work, the first question is whether your employer added UHC's weight-loss program. It is optional and applies only when the employer or another plan sponsor chose to cover weight-loss drugs, though state rules can also require coverage.⁴ Wegovy, Zepbound and Foundayo aren't on UHC's September 1, 2026 employer-plan list, which shows only the most commonly prescribed drugs, so ask HR, as in step 2.¹

What UHC asks for when weight-loss drugs are covered

Even with the benefit in place, your prescriber needs prior authorization. UHC's criteria for Wegovy, Zepbound, Foundayo and Saxenda, effective October 1, 2026, ask for:⁴

• BMI. A body mass index (BMI) of 30 or higher, or 27 or higher with a weight-related condition such as abnormal blood fats (dyslipidemia), high blood pressure, type 2 diabetes or sleep apnea. For children and teens, UHC instead asks for a BMI above the 95th percentile for their age and sex. There is no BMI rule when Wegovy injection is prescribed for MASH.^{4, 24}
• Lifestyle changes. The drug must be used alongside lifestyle changes, such as diet, exercise, behavioral support or a community-based program.⁴
• Age. The minimum age is 12 for Wegovy injection and Saxenda, and older than 16 for the others.⁴

The FDA labels match UHC's minimum age for two of these drugs and are stricter for the others. Wegovy injection is approved for weight reduction from age 12 in children with obesity, and Saxenda from 12 in children with obesity who weigh more than 60 kg (about 132 pounds). Zepbound, Foundayo, Wegovy tablets and Wegovy HD (the 7.2 mg strength) are approved for weight reduction only in adults, so using them before 18 would be off-label, meaning outside the uses FDA approved, even where UHC's age rule allows it.^{4, 24, 25, 26, 27}

UHC's criteria don't require trying older weight-loss drugs first or a set time in a supervised diet program. The same program also includes older drugs such as phentermine, Contrave, Qsymia and orlistat (Xenical). On plans with this benefit, the cardiovascular, MASH and sleep apnea uses are reviewed here under the same rules, except that MASH has no BMI rule. The separate routes are for plans without it.⁴

How long an approval lasts, and what renewal takes

A first approval lasts 4 months for Saxenda, 5 months for Wegovy and 6 months for Zepbound and Foundayo. To renew for 12 months, your records need to show you have lost at least 5% of your starting weight (4% for Saxenda) and are keeping up the lifestyle changes. If you have been on Foundayo, Saxenda, Zepbound or Wegovy (injection or tablets) for six months or less and haven't reached a maintenance dose, UHC allows one extra six-month approval in place of the weight-loss test. That rule only affects how long coverage lasts; your prescriber decides your dose.⁴

For Wegovy injection prescribed for MASH, renewal instead needs records showing the liver disease improved or held steady and has not progressed to cirrhosis.⁴

Wegovy tablets are "typically excluded from coverage," even under this program.⁴ UHC's Advantage drug list is one of its lists for employer plans, not a Medicare Advantage list. It names Wegovy tablets and brand Saxenda among drugs that may be excluded from January 1, 2027, with generic liraglutide among the alternatives.³

How likely is approval? UHC's published figure, 91.7% of prior authorization requests approved in 2025 (including after appeals), leaves out pharmacy drugs, so it doesn't answer that for GLP-1s. UHC says it will add prescription requests to its reporting in 2026.²⁸

Cardiovascular disease, MASH or obstructive sleep apnea: separate routes when weight loss is excluded

Wegovy and Zepbound are FDA-approved for more than weight. On employer plans that exclude weight-loss drugs, separate UHC programs can cover these other uses, subject to your plan's terms. They cover only people whose medical records show one of these conditions; a prescription for weight loss alone is still excluded.^{7, 8}

Wegovy to lower the risk of heart attack, stroke and cardiovascular death

• Age 45 or older, a BMI of 27 or higher, and established cardiovascular disease: a past heart attack or stroke, or peripheral artery disease (narrowed or blocked arteries in the legs or arms) with symptoms. The artery disease must be shown by leg pain on walking plus an ankle-brachial index test below 0.85 at rest, a procedure to restore blood flow to the limb, or an amputation caused by artery disease.^{7, 16}
• Taking, unless you can't, a cholesterol-lowering drug, an antiplatelet drug and a drug from the ACE inhibitor, ARB or ARNI classes, plus a beta blocker after a heart attack.⁷
• A reduced-calorie diet and more activity. No diabetes, an A1C (a test of average blood sugar) no higher than 6.5%, and no class IV (most severe) heart failure. Approval lasts 12 months, for the injection or the tablets.⁷

Wegovy injection for MASH, a liver disease formerly called NASH

• Records showing liver scarring at stage F2 or F3, confirmed by a liver stiffness scan (such as FibroScan or MR elastography) or a liver biopsy in the past 12 months.⁷
• A gastroenterologist or liver specialist (hepatologist) prescribing or consulting, plus a reduced-calorie diet and more activity. Your prescriber must also attest that Wegovy injection won't be started at the same time as Rezdiffra (resmetirom) for the same condition. Unlike the other two routes, this one has no diabetes rule.⁷
• Approval lasts 12 months. Renewal needs records showing the liver disease improved or held steady and has not progressed to cirrhosis.⁷

Zepbound for obstructive sleep apnea

• Age 18 or older and a BMI of 30 or higher. A sleep study must show moderate to severe obstructive sleep apnea (more than 15 breathing pauses or shallow breaths an hour), not mainly central or mixed sleep apnea.⁸
• At least one diet attempt that didn't work, and symptoms despite regular use of a CPAP or similar device, or not being a candidate for one.⁸
• No diabetes, an A1C no higher than 6.5%, and no planned surgery for sleep apnea or obesity. A sleep, lung or ear, nose and throat specialist, or another doctor experienced with sleep apnea, must prescribe or consult. The first approval lasts 6 months.⁸

On employer plans, the MASH route is the only one of these three open to people with type 2 diabetes; on plans with the weight-loss program, type 2 diabetes instead counts as a weight-related condition for the BMI 27 rule.^{7, 8, 4} UHC's Individual & Family plan criteria in Georgia and New York, for example, have routes for the same three conditions.^{12, 5} UHC's rules for the diabetes drugs are next.

Ozempic, Mounjaro, Rybelsus and Trulicity need a type 2 diabetes diagnosis

In UHC's criteria for employer plans, these four drugs are type 2 diabetes medicines. The criteria note that they are not FDA-approved for weight loss and that drugs used for weight loss are typically excluded from coverage.² Medicare and Marketplace plans have their own drug lists; see Medicare plans and Marketplace plans.^{19, 20}

To approve one, UHC needs medical records confirming type 2 diabetes with a lab result in the diabetes range: an A1C of 6.5% or higher, a fasting blood sugar of 126 mg/dL or higher, or a 2-hour glucose tolerance test result of 200 mg/dL or higher. A random blood sugar of 200 mg/dL or higher with classic symptoms also counts. If you were diagnosed more than 2 years ago, chart notes confirming the diagnosis are enough.²

Approvals last 12 months. UHC removed a step-therapy note in April 2024, and the current criteria don't ask you to try metformin or another drug first. UHC may also approve some requests automatically, based on past claims or diagnosis codes.²

Prediabetes, PCOS and off-label use

Prediabetes doesn't meet these criteria, which call for a type 2 diabetes diagnosis.² UHC's weight-loss criteria give examples of weight-related conditions for the BMI 27 rule but don't say whether prediabetes counts.⁴ On Medicare, the Bridge does count prediabetes with a BMI of 27 or higher.⁹

None of the FDA-approved uses in the drug table is polycystic ovary syndrome (PCOS), and UHC's criteria don't mention it.^{2, 4} Using Ozempic or Mounjaro for weight loss, or any of these drugs for PCOS alone, would be off-label. If you have PCOS and also meet the weight criteria above, the approved weight-reduction use can apply.^{24, 26, 27, 25}

If you don't meet these weight criteria, no GLP-1 is FDA-approved for weight loss for you, and using one would be off-label.^{24, 26, 27, 25} Talk with your own doctor. Our page on GLP-1s when you're not obese or overweight explains what that means.

GLP-1 drugs in UHC's rules, and what FDA approved each for

Ozempic and Wegovy both contain semaglutide, and Rybelsus is semaglutide in tablet form. Mounjaro and Zepbound both contain tirzepatide, which acts on two hormone receptors, GIP and GLP-1; UHC groups it with the GLP-1 drugs, as we do.^{29, 24, 30, 31, 26, 2} Trulicity contains dulaglutide, Saxenda liraglutide and Foundayo orforglipron.^{32, 25, 27}

The table's last column follows UHC's employer-plan documents, where "weight-loss program" means covered only if your employer added it or state rules require it. Medicare and Marketplace lists differ.^{2, 4}

Where the table says weight reduction, the approved use is long-term weight loss and maintenance with a reduced-calorie diet and more physical activity. In adults, it applies to obesity, or to overweight plus at least one weight-related health problem.^{24, 26, 27, 25}

Every drug in the table carries a boxed warning and other serious risks, so read what the labels warn about before starting one.^{29, 30, 31, 32, 24, 26, 25, 27} Compounded semaglutide and tirzepatide are mixed by a pharmacy for an individual patient and are not FDA-approved; coverage for compounded drugs is explained below.^{33, 34}

UnitedHealthcare and AARP Medicare plans

Federal law leaves most drugs, or uses of drugs, that Medicaid may exclude out of Part D coverage, including drugs used for weight loss.^{13, 14} Plans that offer enhanced coverage may add weight-loss drugs as a supplemental benefit, so your plan's drug list has the final word.¹³ The Centers for Medicare & Medicaid Services (CMS), which runs Medicare, says Medicare generally does not cover GLP-1s for weight loss.¹⁵

Part D can cover GLP-1s for other uses, such as type 2 diabetes; the Bridge section lists which uses stay with Part D.⁹ Which drugs your plan covers, and for which uses, depends on its drug list and prior authorization rules. UHC's lists differ:^{20, 21}

• An AARP Medicare Advantage list from UHC (formulary 00026002, last updated October 1, 2025) listed Mounjaro, Ozempic, Rybelsus and Trulicity on tier 3 with prior authorization and quantity limits. Quantity limits cap how much can be filled at once. Wegovy and Zepbound were not on it.²⁰
• A UHC Group Medicare Advantage list for employer retiree plans, posted by one employer (formulary 00026005, last updated October 15, 2025), listed Wegovy and Zepbound on tier 4 with prior authorization and quantity limits.²¹

Both lists were still the versions posted online when we checked on October 3, 2026.^{20, 21} The AARP list says updates are posted monthly, so check your plan's current list.²⁰

If your plan doesn't cover a drug you need for a Part D-covered use, you or your prescriber can ask for a coverage determination (the plan's decision on whether it covers the drug for you) or an exception to its drug list rules, which needs your prescriber's statement of the medical reason.^{35, 20} After a denial, you have 65 days from the date on the notice to request the first appeal, called a redetermination; our prior authorization guide walks through every level.³⁵ An appeal can't add weight-loss use, which the law excludes, so see the Bridge instead.¹³

The Medicare GLP-1 Bridge for weight management

The Medicare GLP-1 Bridge is a short-term CMS program running from July 1, 2026, through December 31, 2027. It works outside your Part D plan, whether UHC or another company runs it. In 2026, a single CMS processor, not your plan, handles its prior authorizations, claims and payments.^{22, 9, 23}

It covers Wegovy (injection or tablets), Foundayo tablets and one form of Zepbound, the KwikPen, a pen that holds four weekly doses. It doesn't cover Zepbound's single-dose pens or vials, Ozempic, Rybelsus, Mounjaro or Trulicity, or KwikPen needles.^{16, 36, 23, 9} The Zepbound label says never to share a KwikPen, even with a new needle, because sharing can spread infections carried in the blood.²⁶

You need Medicare drug coverage: a standalone Part D plan, a Medicare Advantage HMO, HMO-POS or PPO plan with drug coverage, a Special Needs Plan, an employer or union group plan, or Medicare's Limited Income Newly Eligible Transition (LI NET) program. Private fee-for-service and some other plan types qualify only with a standalone Part D plan; call 1-800-MEDICARE if you're not sure which type you have.^{16, 9}

Your prescriber must certify that the drug is prescribed for weight reduction along with an ongoing diet and physical activity plan. You must also be 18 or older and have met one of these BMI rules when you started GLP-1 treatment:^{9, 16}

The Bridge isn't for you if you already get a GLP-1 through Part D, or if you have type 2 diabetes, moderate to severe obstructive sleep apnea, or MASH, a form of fatty liver disease with inflammation and liver damage that can lead to scarring, if the scarring is moderate to advanced (stage F2 or F3) but not cirrhosis.^{9, 10} Your Part D plan can cover a GLP-1 for those. Medicare.gov's summary and eligibility quiz say only "fatty liver disease," but CMS's guidance for prescribers is narrower, so if you have fatty liver disease without that degree of scarring, ask your prescriber whether the Bridge applies.^{9, 16}

A prescription written to lower heart attack and stroke risk also goes to Part D. Even so, a past heart attack or stroke can count toward Bridge eligibility when the drug is prescribed for weight.^{9, 16}

The copay is $50 for a one-month supply (28 or 30 days, depending on the drug). Because the Bridge sits outside Part D, your Part D deductible doesn't apply, the copay doesn't count toward your out-of-pocket costs, and Extra Help (the low-income subsidy) can't lower it.^{16, 22}

Getting a Bridge prescription approved

1. Your prescriber sends the prescription to your pharmacy. UHC asks prescribers to add the note "Send to bridge for weight management." Otherwise the pharmacy may bill your UHC plan, which typically doesn't cover weight management. CMS recommends the note but doesn't require it.^{23, 9}
2. The first claim to the Bridge is expected to come back unpaid. That triggers a prior authorization request, which the pharmacy sends to your prescriber, usually within 24 to 72 hours.^{23, 9}
3. Your prescriber completes it, attesting under penalty of perjury that it is accurate. CMS may check Medicare records, for example for type 2 diabetes.⁹
4. The decision is mailed to you and sent to your prescriber within 72 hours of submission. An approval covers refills and dose changes through December 31, 2027, unless you change GLP-1s.^{9, 16}

There are no appeals, but your prescriber can resubmit with corrected or added information.⁹ Medicare.gov's weight-loss drugs page has a short eligibility quiz. You can call 1-800-MEDICARE about eligibility or a request's status, and prescribers can call the CMS Bridge line at 855-273-0102.^{16, 9} If you started a GLP-1 through a self-pay program before July 1, 2026, you may still qualify, judged on your health when you started.^{16, 9}

If you don't qualify, the makers' copay cards are closed to anyone with Medicare, but their cash self-pay prices are not. You need a prescription for an approved use, and you can't bill Medicare for the purchase or count it toward your Part D costs; see which discounts each kind of buyer can use.^{37, 38}

Individual & Family plans from the Marketplace

Weight-loss coverage on these plans depends on the state. In UHC's New York and New Mexico criteria, effective October 1, 2026, Wegovy, Zepbound, Foundayo and Saxenda can be covered for weight loss with prior authorization: a BMI of 40 or higher, or 30 or higher with a weight-related condition, after at least 6 months of lifestyle changes that didn't bring a 5% weight loss.^{5, 11} The New York document also still contains an older Wegovy guideline (GL-523235, effective April 1, 2026) that excludes Wegovy used only for weight loss; if a New York denial cites it as a benefit exclusion, ask UHC to review the request under the newer guideline (GL-610187, effective July 1, 2026).⁵

A note in those documents says weight-loss drugs are denied as a benefit exclusion in all of UHC's other markets. Georgia's criteria, for example, still have the cardiovascular, MASH and sleep apnea routes.^{5, 11, 12} To check your own state's rules, sign in to your UHC member account or call the number on your ID card.¹⁸

UnitedHealthcare Community Plan (Medicaid)

UHC's Community Plan drug lists differ by state, and federal law lets state Medicaid programs exclude drugs used for weight loss.^{17, 14} To check yours, call the member number on your ID card. For the state picture, see how Medicaid programs handle GLP-1s.

Under CMS's voluntary BALANCE Model, CMS negotiates GLP-1 prices and coverage terms with drug makers for state Medicaid programs that join by January 1, 2027, but CMS says the model guarantees no one coverage.¹⁵

If UHC turns you down

Start with the denial letter, which should say why and explain how and by when to appeal.^{39, 40, 35} There are two very different kinds of no.

"You don't meet the criteria." The plan covers the drug for your use, but the request didn't show something UHC requires, such as the diagnosis, your BMI or the renewal weight loss. You can appeal:

• Plans through work. If UHC insures your plan (a fully insured plan), its 2026 member notice gives you 180 days from the denial to appeal in writing, or longer where state law requires, and after an internal appeal of a clinical decision you may have the right to an independent external review.³⁹ If your employer pays the claims itself (a self-funded plan, which may hire a company such as UHC to process them), the Labor Department's claims rule allows at least 180 days and requires the denial letter to describe the appeal steps.^{41, 40}
• Individual & Family (Marketplace) plans. File an internal appeal within 180 days of the denial notice. If UHC still says no, you can ask for an external review, and the final decision letter must tell you how.⁴²
• UHC or AARP Medicare plans. See the steps above, including the 65-day deadline.³⁵
• Community Plan (Medicaid). Appeal to the plan within 60 days of the date on the denial notice. If it upholds the denial, you can ask your state for a fair hearing.⁴³

"Your plan excludes this drug or use." This is a benefit exclusion. UHC's Individual & Family criteria outside New York and New Mexico, Georgia's for example, tell reviewers to deny weight-loss-only Wegovy and Zepbound requests "as a benefit exclusion."^{12, 5} Because the plan itself leaves the use out, more medical records usually won't change this answer.

You can still file an internal appeal, which is worth doing if the request was handled as weight loss when it was really for a covered use, such as lowering cardiovascular risk. UHC's notice describes external review for clinical decisions and, for other cases, sends you to your certificate of coverage, the plan document that lists all of your coverage terms.³⁹ Otherwise, your options are a covered use that you actually have, a change in your benefits, or paying another way.

Cash prices, copay cards and Real Appeal

Lilly and Novo Nordisk sell Zepbound and Wegovy directly to people who pay cash, including people whose UHC plan won't cover them.^{36, 44} Novo Nordisk says that spending won't count toward your deductible or out-of-pocket limit, and Lilly's self-pay terms say not to count it.^{44, 37} If your plan does cover one of these drugs, the makers' copay cards can lower your share, but they exclude anyone with Medicare or other government coverage, and Lilly's ends December 31, 2026.^{37, 44}

See our pages on cash prices for each drug, which discounts each kind of buyer can use, tirzepatide prices, Wegovy and Ozempic prices, Foundayo prices and paying with an HSA or FSA.

Real Appeal, UHC's weight-management program, gives eligible members online coaching and a kit with a body weight scale, a food scale and a portion plate. It comes at no added cost, with no deductible or copay.⁴⁵

An approval is not a safety check

UHC's criteria check diagnoses, BMI and paperwork. Whether a drug is safe for you is a question for your prescriber, using the FDA label.

Who should not take them. All eight brand-name GLP-1 drugs in the drug table (Ozempic, Rybelsus, Mounjaro, Trulicity, Wegovy, Zepbound, Foundayo and Saxenda) carry a boxed warning about thyroid C-cell tumors, which drugs of this type have caused in rodents. Orforglipron, the drug in Foundayo, does not act on the GLP-1 receptor in rats or mice, so those studies could not show whether it causes these tumors, but it does act on the human receptor.²⁷ Whether they cause these tumors in people, including medullary thyroid carcinoma (MTC), is unknown. None of the eight should be used by anyone with a personal or family history of MTC, with the endocrine condition multiple endocrine neoplasia syndrome type 2 (MEN 2), or with a past serious allergic reaction to the drug or its ingredients.^{29, 30, 31, 32, 24, 26, 25, 27}

Compounded semaglutide and tirzepatide. These have no FDA label, and FDA says they do not go through its review for safety, effectiveness and quality before they are sold. It says many side effects reported with compounded products appear consistent with those reported for the FDA-approved drugs, and that such reports are likely underreported because federal law doesn't require most compounding pharmacies to send them to FDA.³⁴ So ask any prescriber how the warnings on this page apply to you.

Warnings on every label. All eight labels also warn about pancreatitis, gallbladder disease, severe stomach and bowel side effects, kidney injury when vomiting or diarrhea causes dehydration, and serious allergic reactions. They also warn about food or liquid getting into the lungs during anesthesia or deep sedation, so your surgical team needs to know you take one. None is recommended for people with severe gastroparesis (very slow stomach emptying), and Foundayo is also not recommended for people with severe liver impairment.^{29, 30, 31, 32, 24, 26, 25, 27}

Low blood sugar and other warnings. All eight warn about low blood sugar, which is more likely with insulin or a sulfonylurea (a diabetes pill that boosts insulin). It has also been reported in adults without type 2 diabetes taking Wegovy, Zepbound or Foundayo (more often after weight-loss surgery, in one Wegovy trial) and in teens without diabetes taking Saxenda. All but Saxenda warn that diabetic eye disease (retinopathy) can get worse in some people with type 2 diabetes, and Wegovy and Saxenda add a faster resting heart rate.^{29, 30, 31, 32, 24, 26, 25, 27}

Pregnancy. The Wegovy, Zepbound, Foundayo and Saxenda labels, and the Mounjaro, Ozempic, Rybelsus and Trulicity labels (based on animal studies), say these drugs may harm an unborn baby. The Zepbound, Foundayo and Saxenda labels, and Wegovy's for weight or cardiovascular use, say to stop once a pregnancy is recognized. The diabetes drugs' labels, and Wegovy's for MASH, say to use them in pregnancy only if the possible benefit justifies the possible risk to the baby. The semaglutide labels (Wegovy, Ozempic and Rybelsus) say to stop at least 2 months before a planned pregnancy.^{24, 26, 27, 25, 29, 30, 31, 32}

Birth control and breastfeeding. If you take birth control pills, the Zepbound, Mounjaro and Foundayo labels advise switching to a non-pill method or adding a barrier method for 4 weeks (30 days with Foundayo) after you start and after each dose increase. Foundayo's label also advises using effective birth control throughout treatment. Breastfeeding is not recommended with Wegovy tablets, Rybelsus or Foundayo.^{26, 31, 27, 24, 30}

Other medicines. All eight labels say these drugs slow stomach emptying, which can change how other pills are absorbed.^{29, 30, 31, 32, 24, 26, 25, 27} The Wegovy, Zepbound, Foundayo and Saxenda labels advise against taking them with any other GLP-1 medicine, and that includes compounded semaglutide or tirzepatide. Foundayo's label also caps the simvastatin dose and says to avoid some drugs that strongly affect the liver enzyme CYP3A4.^{24, 26, 27, 25, 34}

When to get help right away. Get medical help right away for signs of a serious allergic reaction, such as swelling of the face, lips, tongue or throat. Call your prescriber right away about severe stomach pain that won't go away. Wegovy's Medication Guide says to stop the drug in both cases.²⁴

The guide also says to tell your healthcare provider right away about nausea, vomiting or diarrhea that does not go away, and to drink fluids to lower the chance of dehydration. It lists other symptoms to report, including signs of gallbladder problems, a lump in the neck and vision changes in people with diabetes. These are not all the risks, so read the Medication Guide that comes with your prescription.²⁴ Apart from those emergencies, talk with your prescriber or pharmacist before starting, stopping or changing any medicine, including birth control. Report side effects to your prescriber or to FDA at 1-800-FDA-1088.²⁴

Compounded GLP-1s and UHC coverage

Compounded semaglutide and tirzepatide are not FDA-approved, and FDA does not review them for safety, effectiveness or quality before they are sold. FDA says compounded drugs should only be used when a patient's medical needs can't be met by an FDA-approved drug.³⁴

FDA has received reports of side effects, some needing hospital care, that may be related to dosing mistakes with compounded semaglutide, and reports of side effects, some serious, that may be related to compounded doses above the approved labels.³⁴ So a compounded drug is a medical decision for a prescriber, not a way around a coverage denial, and anyone using one should follow the prescriber's directions and the pharmacy label exactly.

UHC pays for a compounded drug only when every condition in its policy is met. Each drug in it must be one your plan covers, used for an FDA-approved purpose and meeting that drug's own approval rules. A drug no longer sold must not have been withdrawn for safety reasons, and the compound can't contain ingredients UHC excludes. There must also be one of these needs:⁴⁶

• The compound needs a unique vehicle, meaning the inactive base that carries the drug.
• A different dosage form is needed because of your age, weight or inability to take a solid form.
• A different formulation is needed because you are allergic to or can't tolerate an inactive ingredient in the commercial product.
• The commercial product is on FDA's drug shortage list or the one kept by ASHP, the American Society of Health-System Pharmacists.

A lower price or a plan's exclusion of the brand-name drug is not one of the listed needs.⁴⁶ So on a plan that excludes weight-loss drugs, UHC's rule doesn't allow payment for compounded semaglutide or tirzepatide used for weight loss either.^{46, 4}

PlexusDx, the publisher of this page, offers compounded GLP-1 programs. Under PlexusDx's Terms of Service, they are for adults 18 and older and are self-pay, not billed to UHC or any other insurer. So they can't get UHC to pay or give you the $50 Bridge price. Their prices are on our page about GLP-1 costs without insurance.

PlexusDx itself is neither a medical practice nor a pharmacy. Whether to prescribe is up to a U.S.-licensed clinician from Lone Star Virtual Health, the company that provides PlexusDx's prescribers. For the compounded medicine, PlexusDx uses only state-licensed 503A compounding pharmacies. If you have type 2 diabetes, UHC generally covers the diabetes GLP-1s with prior authorization, so start with your plan.^{1, 2}

PlexusDx does not sell or ship brand-name medications such as Wegovy or Zepbound. If you prefer a brand-name, FDA-approved medication, your provider may write a prescription you can fill at the pharmacy of your choice. Whether UHC helps pay for it still depends on your plan and the prior authorization rules on this page. If you don't meet UHC's clinical criteria for these drugs, start with your own doctor, who can check your health history against your plan's rules, before you pay PlexusDx or any other online seller.

Sources

1. 2026 Prescription Drug List, commercial plans (effective September 1, 2026), UnitedHealthcare, accessed October 3, 2026.
2. Prior Authorization/Notification: Diabetes Medications, GLP-1 and Dual GIP/GLP-1 Receptor Agonists (Program 2026 P 1332-8, effective July 1, 2026), UnitedHealthcare, accessed October 3, 2026.
3. Advantage 3-Tier PDL Update Summary (effective January 1, 2027), UnitedHealthcare, accessed October 3, 2026.
4. Prior Authorization/Notification: Weight Loss/Appetite Suppression Medication Coverage (Program 2026 P 1114-23, effective October 1, 2026), UnitedHealthcare, accessed October 3, 2026.
5. Individual and Family Plan Clinical Criteria, New York (effective October 1, 2026), UnitedHealthcare, accessed October 3, 2026.
6. FDA Approves First New Molecular Entity Under National Priority Voucher Program (April 1, 2026), U.S. Food and Drug Administration, accessed October 3, 2026.
7. Wegovy, Cardiovascular Risk Reduction and MASH Only: Prior Authorization/Non-Formulary (Program 2026 P 1445-4, effective May 1, 2026), UnitedHealthcare, accessed October 3, 2026.
8. Zepbound, Obstructive Sleep Apnea Only: Prior Authorization/Non-Formulary (Program 2026 P 1475-3, effective September 1, 2026), UnitedHealthcare, accessed October 3, 2026.
9. Medicare GLP-1 Bridge: Information for Providers (page last modified August 6, 2026), Centers for Medicare & Medicaid Services, accessed October 3, 2026.
10. Definition & Facts of NAFLD & NASH (last reviewed April 2021), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, accessed October 3, 2026.
11. Individual and Family Plan Clinical Criteria, New Mexico (effective October 1, 2026), UnitedHealthcare, accessed October 3, 2026.
12. Individual and Family Plan Clinical Criteria, Georgia (effective October 1, 2026), UnitedHealthcare, accessed October 3, 2026.
13. 42 U.S. Code § 1395w-102, Prescription drug benefits, Legal Information Institute, Cornell Law School, accessed October 3, 2026.
14. 42 U.S. Code § 1396r-8, Payment for covered outpatient drugs, Legal Information Institute, Cornell Law School, accessed October 3, 2026.
15. BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model, CMS Innovation Center, accessed October 3, 2026.
16. Weight loss drugs, Medicare.gov, Centers for Medicare & Medicaid Services, accessed October 3, 2026.
17. UnitedHealthcare Community Plan: Q4 2026 Preferred Drug List Updates (effective October 1, 2026), UnitedHealthcare, accessed October 3, 2026.
18. Prescription Drug Lists, UnitedHealthcare, accessed October 3, 2026.
19. Colorado Individual & Family Plans 2026 Prescription Drug List (effective January 1, 2026), UnitedHealthcare, accessed October 3, 2026.
20. 2026 Complete Drug List (Formulary), AARP Medicare Advantage Giveback from UHC NC-13 and NC-14 (HMO-POS), formulary ID 00026002 (last updated October 1, 2025), UnitedHealthcare, accessed October 3, 2026.
21. 2026 Complete Drug List (Formulary), UnitedHealthcare Group Medicare Advantage, formulary ID 00026005 (last updated October 15, 2025; posted on the University of Arkansas System benefits site), UnitedHealthcare, accessed October 3, 2026.
22. Medicare GLP-1 Bridge, Centers for Medicare & Medicaid Services, accessed October 3, 2026.
23. Medicare GLP-1 Bridge program: What you need to know (August 11, 2026), UnitedHealthcare (UHCprovider.com), accessed October 3, 2026.
24. WEGOVY (semaglutide) injection and tablets: prescribing information and Medication Guide, Novo Nordisk, via DailyMed, National Library of Medicine, accessed October 3, 2026.
25. SAXENDA (liraglutide) injection: prescribing information, Novo Nordisk, via DailyMed, National Library of Medicine, accessed October 3, 2026.
26. ZEPBOUND (tirzepatide) injection: prescribing information, Eli Lilly and Company, via DailyMed, National Library of Medicine, accessed October 3, 2026.
27. FOUNDAYO (orforglipron) tablets: prescribing information, Eli Lilly and Company, via DailyMed, National Library of Medicine, accessed October 3, 2026.
28. CMS Interoperability and Prior Authorization Final Rule: prior authorization made clear, UnitedHealthcare, accessed October 3, 2026.
29. OZEMPIC (semaglutide) injection: prescribing information, Novo Nordisk, via DailyMed, National Library of Medicine, accessed October 3, 2026.
30. RYBELSUS and OZEMPIC (semaglutide) tablets: prescribing information, Novo Nordisk, via DailyMed, National Library of Medicine, accessed October 3, 2026.
31. MOUNJARO (tirzepatide) injection: prescribing information, Eli Lilly and Company, via DailyMed, National Library of Medicine, accessed October 3, 2026.
32. TRULICITY (dulaglutide) injection: prescribing information, Eli Lilly and Company, via DailyMed, National Library of Medicine, accessed October 3, 2026.
33. Human Drug Compounding, U.S. Food and Drug Administration, accessed October 3, 2026.
34. FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight Loss, U.S. Food and Drug Administration, accessed October 3, 2026.
35. Appeals in a Medicare drug plan, Medicare.gov, Centers for Medicare & Medicaid Services, accessed October 3, 2026.
36. Zepbound (tirzepatide) at LillyDirect, Eli Lilly and Company, accessed October 3, 2026.
37. Zepbound savings and insurance options, with savings card terms and conditions, Eli Lilly and Company, accessed October 3, 2026.
38. Wegovy savings offer and self-pay offer terms, Novo Nordisk (NovoCare), accessed October 3, 2026.
39. Getting the Most From Your Health Care Coverage (2026 member notice), UnitedHealthcare, accessed October 3, 2026.
40. 29 CFR § 2560.503-1, Claims procedure, Legal Information Institute, Cornell Law School, accessed October 3, 2026.
41. Self-insured plan (glossary), HealthCare.gov, Centers for Medicare & Medicaid Services, accessed October 3, 2026.
42. Internal appeals, HealthCare.gov, Centers for Medicare & Medicaid Services, accessed October 3, 2026.
43. 42 CFR § 438.402, General requirements (Medicaid managed care appeals), Legal Information Institute, Cornell Law School, accessed October 3, 2026.
44. Wegovy (semaglutide) cost, coverage and savings resources, Novo Nordisk (NovoCare), accessed October 3, 2026.
45. Real Appeal weight management program, UnitedHealthcare, accessed October 3, 2026.
46. Prior Authorization/Notification: Compounds and Bulk Powders (Program 2026 P 1014-19, effective July 1, 2026), UnitedHealthcare, accessed October 3, 2026.

How we made this page

This page replaces an earlier PlexusDx post that misstated UHC's rules, including its A1C cutoff and a supposed required trial of other diabetes drugs, and suggested that PlexusDx's genetic test could help win an insurance approval. None of that was carried over.

For this version, AI tools read the documents in the sources list, all opened on October 3, 2026, and drafted the text and tables from them: UHC's clinical pharmacy criteria (cited by program number and effective date), its state Individual & Family plan criteria, drug lists and member notices; CMS and Medicare.gov pages on Part D, drug plan appeals and the GLP-1 Bridge; the federal laws and rules cited; the FDA labels for the eight GLP-1 drugs and FDA's pages on compounded drugs; and Lilly's and Novo Nordisk's terms. UHC's rules differ by plan type and by state, and each sits in its own long document with its own effective date. Later AI review passes then checked the page against the cited documents and for clinical, regulatory, search-policy, reader and PlexusDx-claim problems, and the page was revised in response to their findings; these automated checks are not a medical or legal review.

We could not see any member's own plan documents, so the page explains how to check yours. Drug, plan and program names belong to their owners and are used only to identify them; naming them does not mean any owner endorses PlexusDx or this page. Jay Hastings reviewed and approved this version on October 19, 2026 and is responsible for what it says. Dr. Asad K. Niazi, MD, MPH, reviewed the medical content on October 17, 2026. He is co-founder and CEO of Lone Star Virtual Health, the company that provides PlexusDx's prescribing clinicians, so he has a business relationship with PlexusDx.

PlexusDx sells compounded GLP-1 treatment, so we have a financial interest in this topic. Read our editorial policy.