With obesity rates steadily increasing, glucagon-like peptide-1 (GLP-1) medications have garnered significant attention as a potential solution. Drugs like Ozempic, Rybelsus, Wegovy, Zepbound, and Mounjaro are surging in popularity. Saxenda, a GLP-1 drug used for weight loss, is an injectable brand-name prescription medication approved by the Food and Drug Administration (FDA) for chronic weight management. It can be used in adults with obesity or who are overweight and have at least one weight-related health condition, such as hypertension (high blood pressure) or high cholesterol. Saxenda can also be used in pediatric patients 12 years or older with obesity and a starting body weight of more than 132 pounds. For those considering Saxenda, understanding its coverage under United Healthcare (UHC) is crucial.
Understanding GLP-1 Medications
GLP-1 drugs were originally developed to help manage type 2 diabetes. They stimulate the body to produce more insulin when blood sugar levels rise. The boost in insulin helps lower glucose levels, which helps control type 2 diabetes. Several of these drugs, such as Wegovy and Zepbound, were approved for use as a treatment for obesity, obstructive sleep apnea, heart attack, or stroke prevention in those who have already experienced a cardiovascular event. GLP-1s tell the body to make more insulin when blood sugar rises after eating. Insulin helps lower blood sugar levels. It’s important to know that GLP-1s alone can't treat type 2 diabetes. GLP-1s can make you feel full after eating less food, which can help you lose weight. Health care providers may prescribe GLP-1s for people who have type 2 diabetes and may benefit from losing weight to help manage a coexisting condition. GLP-1 agonists may have other benefits, in addition to helping manage type 2 diabetes and weight loss. GLP-1s are FDA-approved to treat type 2 diabetes, weight loss (in certain populations) or both.
Does United Healthcare Cover Saxenda?
Coverage for Saxenda with United Healthcare depends on your specific plan. It’s hard to say if your plan will cover Saxenda, as coverage varies by plan. According to United Healthcare (UHC), employers may opt to cover weight loss medication in their health insurance plans if they are able to comply with UHC’s prior authorization requirements. This means that even if your plan provides coverage for this medicine, your healthcare provider will likely need to submit a prior authorization (PA)-documentation explaining why you need this medication.
Prior Authorization: What to Expect
Even if your plan provides coverage for Saxenda, your healthcare provider will likely need to submit a prior authorization (PA). The approval process may take some time. Your healthcare provider can send a prescription to your preferred pharmacy, and the pharmacy staff will submit your Saxenda prescription to your insurance company.
Here's what might happen:
- Your Saxenda prescription will be covered: This is the best-case scenario.
- Your prescription will require a PA: If your plan requires a PA, your healthcare provider will send supporting documentation, such as your weight, lab results, and notes from your visit, to your health insurance company. The insurance company will review the information and determine whether it will cover the medicine.
- Your plan will deny your prescription: If UHC won’t cover Saxenda, it doesn’t mean you have to give up hope of weight loss.
Criteria for Prior Authorization
To get Saxenda covered, the patient’s body mass index (BMI) needs to meet the criteria for obesity. For adults, this is a BMI of 30 or more or of 27 or more with at least one weight-related medical condition, such as Type 2 diabetes, sleep apnea, high cholesterol, or high blood pressure. A weight loss of at least 4% (for example, an 8 lb.) may be required for continued authorization, typically put in place for 12 months. Additionally, supply limits may apply.
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How to Determine Your Coverage
There are a few ways to find out whether your United Healthcare plan covers Saxenda.
- Contact your health insurance plan directly: Within a few minutes, you should get information about Saxenda coverage, and possibly the cost as well.
- Check with your pharmacy: Once your healthcare provider sends your prescription to your pharmacy, pharmacy staff can submit the prescription to your insurance plan and notify you of the next steps, such as whether a PA is required. Drug prices vary by pharmacy, and Saxenda may be more affordable at some pharmacies than others.
Cost of Saxenda
If you are paying with insurance, your copay or coinsurance will vary based on your specific plan. If your specific United Healthcare plan approves coverage for Saxenda, the cost will depend on whether it is a preferred drug and what tier it is on. Drugs on higher tiers have higher copays than drugs on lower tiers.
If you are paying without insurance or discounts, a typical one-month prescription of Saxenda would cost about $1,805. This price is for a box of five, 18 mg pens, which is a one-month supply based on using a maximum dose of 3 mg once daily.
Savings Options
If UHC won’t cover Saxenda, there are savings options you can discuss with your healthcare provider or pharmacist. Once you choose where to have your healthcare provider send your prescription, you can print or download a Saxenda coupon to show your pharmacist and save close to $600 per month.
Alternatives to Saxenda
If UHC won’t cover Saxenda, there are also alternative treatments to consider. For example, you may be able to get coverage for liraglutide (generic Victoza) off-label for weight loss. Other Saxenda alternatives include Ozempic (semaglutide), Mounjaro (tirzepatide), metformin, Qsymia (phentermine/topiramate), and Contrave (naltrexone/bupropion). You can discuss these options with your healthcare provider to see whether any would be suitable for you based on factors such as FDA-approved uses and potential side effects.
Read also: Does UnitedHealthcare Cover Ozempic?
Important Considerations Regarding GLP-1 Medications
Chief Data & Analytics Officer Craig Kurtzweil and Chief Medical Officer Dr. Rhonda Randall have a word of caution for employers: Don’t rush to make decisions about covering these drugs. “GLP-1s shouldn’t be looked at as a single-point solution. Individuals who take these drugs are more successful at achieving and maintaining their weight loss goals when they are part of a comprehensive lifestyle management program.
“UnitedHealthcare constantly monitors drugs that are under development as well as potential new uses for those already approved,” explains Susan Maddux, chief pharmacy officer for UnitedHealthcare Employer & Individual. “It’s important for us to stay ahead of the curve and develop a strategy around availability and cost. The average cost of GLP-1 drugs can exceed $1,000 per patient per month. The combination of high drug costs and a large patient population may have profound implications for employers’ overall health care spend. As a result, employers may find it difficult to decide whether they should cover these drugs or exclude them.
“We’re starting to see a trend where many people stop taking GLP-1s after a few months,” Kurtzweil says. “We have to be cautious with GLP-1s, as we’re still learning where they are most effective and what the long-term side effects are,” explains Dr. Randall. GLP-1 medications for weight loss are currently available only as injections, but pill forms are in development. These new forms could improve accessibility and enhance the user experience.
The Importance of a Holistic Approach
Weight-loss programs that take a whole-person approach - including pharmaceutical, clinical and behavioral support - can be more effective at treating all aspects of a person’s health. While employers may be feeling pressure from employees to cover GLP-1s, it’s imperative for them to consider the costs and adherence challenges associated with these drugs.
UnitedHealthcare’s Initiatives for Weight Management
UnitedHealthcare is addressing the challenges of weight management through comprehensive programs.
Read also: United Healthcare Weight Loss
Total Weight Support, introduced in 2024, aims to tackle these challenges by taking a whole-person, evidence-based approach to weight loss. The program combines personalized coaching, education, and tracking tools to help employees with medication adherence and lifestyle changes. Real Appeal Rx offers live 1:1 or group coaching sessions, medication-related support from pharmacists, and progress tracking tools like a smart scale and fitness app. “We want to create long-term, sustainable weight loss-not a yo-yo effect,” Dr. Randall said.
Real Appeal Rx® provides whole-person support addressing medication adherence, nutrition, physical activity and the emotional and social experiences of the GLP-1 weight loss medication journey. Coaching: Live 1:1 and/or group coaching, providing members with personalized support and expert guidance. WeightWatchers for Business, which offers flexible, self-directed methods for achieving weight loss goals and provides access to online communities for support. Content library: Robust library of recipes, meal plans and tools for meal selection.
NC Medicaid's Decision Regarding GLP-1 Coverage
Given shortfalls in state funding, effective Oct. 1, 2025, NC Medicaid coverage for GLP-1s for the treatment of obesity, which is an optional benefit for Medicaid programs, will be discontinued.
NC Medicaid remains committed to the potential of GLP-1s for the treatment of obesity; however, at this time the lack of funding for the program prohibits continued coverage for weight management purposes. GLP-1s will continue to be covered for the indications of diabetes, reduction in cardiovascular death, heart attack and stroke in obese adults with cardiovascular disease, noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) and severe obstructive sleep apnea (OSA).
Changes to the Preferred Drug List (PDL)
Effective Oct. 1, 2025, Wegovy, Zepbound and Saxenda will be removed from the Preferred Drug List (PDL) as an off-cycle change. Saxenda will no longer be covered for any indication. The Non-Incretin Mimetics class of drugs for treatment of obesity will continue to be managed through the PDL. Drugs in the Preferred status on the PDL include: diethylpropion, phendimetrazine and phentermine. These products do not require prior approval. Coverage of Wegovy and Zepbound will be managed through prior authorization, using clinical criteria established by the State for the below Food and Drug Administration (FDA) approved indications.
Continued Coverage for Specific Indications
- Wegovy: To reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease who are obese. For the treatment of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), formerly known as nonalcoholic steatohepatitis (NASH), with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis) in adults.
- Zepbound: To treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity.
Prior Authorization Requirements for NC Medicaid
Providers will need to obtain a new prior authorization for beneficiaries receiving Wegovy and Zepbound, effective Oct. 1, 2025. Current prior authorizations will no longer be valid after Sept. 30, 2025. Prior authorization requests can be submitted beginning Oct. 1, 2025. There will be no changes to coverage for GLP-1 medications for the treatment of diabetes. Additionally, Weight Management (Non-Incretin Mimetics) will still be covered as listed on the PDL.
Understanding Prescription Drug Lists (PDLs)
A Prescription Drug List (PDL) - also called a formulary - is a list of commonly used medications, organized into cost levels, called tiers. These costs are decided by your employer or health plan. Sign into your member account or call the number on your health plan ID card to see your PDL and get specific information about your pharmacy benefits.
Preventive Care Medications
As part of Health Care Reform, health plans must cover certain Preventive Care Medications at no cost to you. The health reform law (Affordable Care Act) requires most health plans to pay for birth control (contraceptives and sterilization) for women at no cost to you. Some organizations can choose not to cover birth control (contraceptives) as part of their group health plan for religious reasons. The lists contain preventive medications that may be covered under your plan. If your plan has one of these lists, your insurance benefit may be applied before you meet your deductible for the listed preventive medications. This list includes certain classes of preferred drugs offered at no out-of-pocket cost to you.
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