United Healthcare Wegovy Prior Authorization Process and Coverage

United Healthcare requires a prior authorization for Wegovy, a prescription medication used to treat obesity and weight-related conditions.

The prior authorization process typically takes 2-3 business days to complete, but may take longer in some cases.

To initiate the prior authorization process, patients or their healthcare providers must submit a request to United Healthcare.

The request must include the patient's medical history, current medications, and any relevant medical conditions.

United Healthcare will review the request and may request additional information before making a decision.

Once the prior authorization is approved, patients will have access to Wegovy coverage through their United Healthcare plan.

If you're approved for Wegovy through United Healthcare's prior authorization process, you can start taking your medication.

You'll need to fill your prescription at your pharmacy of choice.

If your UnitedHealthcare plan doesn't cover Wegovy, you'll need to ask for a list of covered alternatives and share it with your healthcare provider.

Prior authorization could be denied if your plan doesn't cover Wegovy, so it's essential to check your coverage before starting treatment.

To find out if your UnitedHealthcare plan covers Wegovy, call the service number on the back of your insurance card or check the UHC website.

You can also use Novo Nordisk's online tool to check if your insurance covers Wegovy.

If your plan covers Wegovy, you might want to ask UnitedHealthcare a few more questions, such as what steps you need to take to get coverage and what your copay will be.

Here are some questions to ask UnitedHealthcare:

The prior authorization process can seem daunting, but it's actually a straightforward process. Your healthcare provider will submit a prior authorization request to your insurance company, which requires sharing detailed information from your medical record, like your health history and medications you’ve already tried.

Most insurance plans require prior authorization before covering Wegovy, and your healthcare provider will need to submit paperwork to your insurance provider stating that it is a medically necessary treatment. This process enables insurance companies to ensure the drug is medically necessary and is being prescribed safely.

To get prior authorization for Wegovy, your healthcare provider will need to complete a prior authorization form, which is usually a short 1–2 page piece of paperwork. Your healthcare provider or their staff will complete the form on your behalf, and you may need to share some information with them to include on the form.

The form may ask for additional information, such as your contact information and date of birth, what you will be taking Wegovy for (weight loss or cardiovascular risk reduction), your prescribed dosage of Wegovy, your history with weight loss or other medications you’ve tried, and your plan to make other lifestyle changes while taking Wegovy.

Here are the key steps to follow:

If your prior authorization for Wegovy is denied, you can appeal.

Administrative or procedural errors can lead to prior authorization denials, often due to clerical errors or missing information and test results.

If your prior authorization for Wegovy is denied, don't worry - there are things you can do to get the decision overturned. The most common reasons for denials include not trying other, lower-cost medications for weight loss first, insurance plans not believing Wegovy is medically necessary, and paperwork errors.

You can appeal a prior authorization denial for Wegovy by first reaching out to your insurer and finding out why you were denied. Administrative errors and doubts about medical necessity may be easily overturned by submitting additional information.

Most states have 3 levels of appeals. First-level appeals involve a phone call to your insurance company asking for reconsideration. Your healthcare provider may need to submit additional medical information as evidence that your approval was wrongly denied.

Here are the 3 levels of appeals:

If your prior authorization for Wegovy is denied, you have the right to appeal. Typically, there are 3 levels of appeals - 2 internal and 1 external. It's essential to work with your healthcare provider and insurance company throughout this process and follow up regularly.

If you've been denied prior authorization for Wegovy, don't worry, you can appeal the decision.

First, reach out to your insurer to find out why you were denied. Administrative errors and doubts about medical necessity may be easily overturned by submitting additional information.

Your healthcare provider can continue with the appeals process if needed, and it's best if they do the first-level appeal by phone, as insurers are required to let them talk to the reviewer about the decision.

Second-level appeals involve review by a medical director at your insurance company, where you'll need to prove your request should be accepted within your plan's coverage guidelines.

If the denial persists, the appeal goes to the final level – independent external review, where a licensed healthcare professional and an independent reviewer at your insurance company evaluate your request based on medical necessity.

You can talk to your healthcare provider if you have questions about navigating the appeals process, and together, you can make sure you get the treatment you need.