UnitedHealthcare/Optum GLP-1 Coverage

Step therapy may be required — you may need to try a lower-cost medication first.

• •Strict step therapy protocols are common across UHC plans.
• •All GLP-1s are covered with PA, but Foundayo is pending approval.
• •Copays are higher if you're on a non-preferred tier.
• •OptumRx pharmacy network is required for lowest prices.

1. 1.Use Optum's PA portal to submit requests and track status in real time.
2. 2.Ensure your provider uses the correct diagnosis codes (e.g., E66.9, Z68.41 for BMI ≥30).
3. 3.Ask your doctor to include a treatment plan showing failed attempts with diet and exercise.

1. 1.Submit a formal appeal with a letter from your provider and a copy of your medical history.
2. 2.Request a review by an independent medical reviewer if the initial appeal is denied.
3. 3.Highlight any comorbidities like prediabetes or hypertension in your appeal.

• GLP-1 Denied by Insurance? Your Complete Action Plan for 2026
• Prior Authorization for Medications: How to Get Approved in 2026
• Insurance Stopped Covering Your GLP-1 in 2026: What to Do Next