United Healthcare Expands Wegovy Coverage, Millions Now Eligible

Does United Healthcare cover Wegovy? This question has become increasingly important as obesity rates continue to climb, with more than 42% of Americans now classified as obese according to the CDC. Wegovy, a weekly injection approved by the FDA in 2021, has demonstrated remarkable effectiveness for weight management, making it a sought-after treatment option for many struggling with weight-related health issues.

Firstly, we need to understand how Wegovy works for weight loss before discussing coverage details. In clinical trials involving 1,961 participants, those receiving Wegovy lost an average of 15% of their body weight after 68 weeks, compared to just 2% in the placebo group. Additionally, 84% of people taking Wegovy achieved at least a 5% weight reduction. Beyond weight loss, the medication has shown significant cardiovascular benefits, with a recent study revealing a 20% lower risk of death from heart and circulatory diseases. This explains why many are wondering if United Healthcare covers Wegovy for weight loss in 2023, especially for those with a BMI of 30 kg/m² or greater, or at least 27 kg/m² with weight-related health problems.

In this article, we’ll explore United Healthcare’s expanded coverage of Wegovy, examine who qualifies under the new policy, and provide insights into the medication’s effectiveness, safety profile, and long-term usage recommendations.

United Healthcare Expands Coverage for Wegovy Nationwide

United Healthcare has significantly expanded its coverage for Wegovy (semaglutide), making this weight management medication accessible to millions more Americans. This expansion represents a major shift in how the insurance giant approaches coverage for weight management medications.

Who is now eligible under the new policy

Under the expanded coverage policy, United Healthcare members who are 12 years and older may qualify for Wegovy prescriptions. The eligibility criteria focus on specific health metrics and conditions. Patients must have either a Body Mass Index (BMI) of 30 or greater (classified as obesity) or a BMI between 27 and 30 (overweight) alongside at least one weight-related health condition such as hypertension, sleep apnea, or Type 2 diabetes.

Moreover, United Healthcare now covers Wegovy for cardiovascular risk reduction in adults with established cardiovascular disease. To qualify under this indication, patients must be 45 years or older, have a BMI ≥ 27 kg/m², and have documented cardiovascular disease such as prior myocardial infarction, stroke, or symptomatic peripheral arterial disease. These patients must also commit to lifestyle modifications, including reduced reduced-calorie diet and increased physical activity.

When the coverage expansion takes effect

The timeline for coverage implementation varies by state and plan type. For instance, in Texas, the Health and Human Services Commission will add formulary coverage for Wegovy starting December 27, 2024. Subsequently, Texas Managed Care Organisations must implement the clinical prior authorisation process manually by December 27, 2024, with automated systems following by January 27, 2025.

In Louisiana, the expansion has an earlier timeline, with Medicaid coverage for Wegovy’s cardiovascular indication beginning July 1, 2024. This state-by-state rollout reflects the gradual nature of the coverage expansion.

Which states and plans are included

The coverage expansion encompasses various United Healthcare plans across multiple states, though with notable differences. Texas Children’s Health Plan will implement Wegovy coverage through pharmacy benefits starting December 27, 2024. Similarly, Louisiana Healthcare Connections will cover Wegovy for specific eligible populations with established cardiovascular disease.

Nevertheless, coverage limitations exist for certain plan types. United Healthcare Medicare plans generally don’t cover Wegovy since Medicare doesn’t typically cover obesity medications. However, some select Medigap and Medicare Advantage plans may offer coverage.

For members with United Healthcare commercial plans, the initial authorisation period is typically four months, with possible reauthorization for an additional 12 months if patients lose at least 5% of their baseline body weight.

For more information about United Healthcare’s Wegovy coverage and eligibility requirements, please consult their official website or contact your insurance representative.

Clinical Trials Show Wegovy Delivers Significant Weight Loss

Clinical trial results have firmly established Wegovy (semaglutide) as a powerful tool for weight management, which explains why United Healthcare has expanded coverage for this medication. The impressive clinical data demonstrate why many patients are asking whether their insurance will cover this effective treatment.

How much weight did patients lose in trials

The landmark STEP 1 trial revealed that patients taking weekly 2.4mg Wegovy injections lost an average of 14.9% of their body weight over 68 weeks, versus just 2.4% in the placebo group. In fact, this weight loss trajectory continued for approximately 65 weeks before stabilizing. Notably, the STEP 3 trial, which combined Wegovy with intensive behavioral therapy and an initial low-calorie diet, produced even more dramatic results—patients lost an average of 16.0% of their baseline weight compared to just 5.7% with placebo.

Long-term data is equally compelling. A 4-year study confirmed that patients maintained significant weight reduction, with semaglutide users sustaining an average 10.2% weight loss versus just 1.5% in the placebo group.

What percentage of users saw 5%, 10%, or 15% reductions

The breakdown of weight loss achievements is particularly impressive:

• 86.4% of Wegovy users lost at least 5% of their body weight (versus 31.5% on placebo)
• 69.1% lost at least 10% (versus 12.0% on placebo)
• 50.5% lost at least 15% (versus 4.9% on placebo)
• Approximately one-third of participants achieved at least 20% weight reduction

These thresholds are clinically significant, as even a 5-10% weight reduction can meaningfully improve health outcomes related to obesity.

How Wegovy compares to a placebo and other drugs

While Wegovy consistently outperforms placebo in clinical trials, recent head-to-head comparisons with newer medications show varying results. A 72-week trial comparing tirzepatide (Zepbound) to semaglutide (Wegovy) found that tirzepatide users lost about 20.2% of body weight compared to 13.7% with semaglutide. Furthermore, 32% of tirzepatide users achieved weight loss of at least 25%, versus 16% of semaglutide users.

The difference in effectiveness likely stems from tirzepatide’s dual mechanism of action—it mimics both GLP-1 and GIP hormones, whereas Wegovy works primarily through GLP-1 activation. This expanded coverage from United Healthcare acknowledges Wegovy’s proven effectiveness despite newer alternatives entering the market.

Wegovy Also Reduces Cardiovascular Risk, Studies Confirm

Beyond weight loss, Wegovy’s expanding insurance coverage through United Healthcare stems largely from its proven cardiovascular benefits. The FDA recently approved Wegovy specifically to reduce cardiovascular death, heart attack, and stroke risk in adults with cardiovascular disease who are obese or overweight.

What the SELECT trial revealed about heart health

The groundbreaking SELECT (Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity) trial examined 17,604 adults with established cardiovascular disease and overweight/obesity but without diabetes. This extensive study, conducted across 41 countries, demonstrated that Wegovy significantly reduced major adverse cardiovascular events (MACE) by 20% compared to placebo.

The trial revealed several specific improvements:

• 20% reduction in combined risk of cardiovascular death, non-fatal heart attack, and non-fatal stroke[172]
• 15% decrease in cardiovascular-related deaths
• 28% reduction in heart attacks for patients already taking heart medications
• 7% decrease in non-fatal strokes
• 19% lower all-cause mortality rate

These benefits appeared early, within six months of starting treatment, and continued to expand throughout the follow-up period.

How Wegovy benefits patients with obesity and heart disease

Consequently, Wegovy became the first weight loss medication also approved to help prevent life-threatening cardiovascular events. The medication appears to work through multiple pathways beyond weight loss alone, improving various cardiovascular risk factors, including blood pressure, waist circumference, glycemic control, and levels of lipids and C-reactive protein.

Essentially, patients with existing heart conditions showed even greater benefits. Those with heart failure who received Wegovy experienced significant improvements in outcomes regardless of ejection fraction type. Furthermore, patients with previous coronary artery bypass grafting (CABG) surgery, who typically face high, persistent ischemic event risk, saw consistent reductions in cardiovascular outcomes with semaglutide treatment.

Most importantly, these cardiovascular benefits emerged in a patient population already receiving standard cardiovascular preventative treatments, including statins and blood pressure medications. This explains why United Healthcare now covers Wegovy specifically for cardiovascular risk reduction in adults with established cardiovascular disease.

Experts Weigh In on Long-Term Use and Side Effects

As patients consider whether their United Healthcare plans cover Wegovy, understanding potential side effects and long-term usage guidelines remains crucial for making informed decisions about this weight management treatment.

What are the most common side effects?

Medical experts note that gastrointestinal issues dominate the side effect profile. In clinical trials, nausea affected 44% of patients, diarrhoea occurred in 30%, vomiting in 24%, and constipation in 24%. Other common reactions include abdominal pain (20%), fatigue, headache, dizziness, and bloating. Fortunately, most side effects are temporary and typically diminish over time.

“Some of the common side effects seen by those taking Wegovy include GI-related issues, such as vomiting, diarrhoea, and nausea,” explains Dr. Hill.

More serious but rare concerns include pancreatitis, gallbladder problems, kidney issues, and increased heart rate. Approximately one-third of SELECT trial participants reported serious side effects, with about 17% discontinuing treatment because of them.

How long should patients stay on Wegovy?

Medical consensus supports long-term use of Wegovy for ongoing weight management. “Obesity is a chronic illness, and it should be treated chronically over the long haul,” states Dr. Lazarus. Studies show patients who discontinued Wegovy regained most lost weight within a year.

“If a person loses weight on an anti-obesity medication and stops it, most of the clinical studies have shown that they’ll regain at least two-thirds of the lost weight within 12 months,” Dr. Lazarus continues.

What doctors recommend for safe use

For optimal results and safety, healthcare providers recommend:

1. Gradual dose escalation—starting at low doses and increasing monthly—to minimise side effects.
2. Maintaining adequate hydration, particularly important since dehydration from GI symptoms could worsen kidney function.
3. Combining medication with lifestyle modifications. “Those taking [Wegovy] should have a commitment to lifestyle changes through diet and movement and be under the supervision of their doctor and dietitian,” advises Dr. Hill [211].
4. Regular monitoring, including kidney function tests for patients experiencing severe GI symptoms.

Ultimately, most patients tolerate the medication well when properly managed, although ongoing vigilance for potential long-term effects remains important.

Conclusion

Overall, United Healthcare’s expanded coverage of Wegovy represents a significant advancement in making effective weight management treatments accessible to millions of Americans. The medication’s dual benefits certainly make it a valuable option for those struggling with obesity and weight-related health issues. Clinical trials have consistently demonstrated Wegovy’s effectiveness, with patients losing an average of 15% body weight while experiencing a 20% reduction in cardiovascular risks. These impressive results explain why insurance providers like United Healthcare have broadened their coverage policies.

Nevertheless, patients should carefully consider both benefits and potential drawbacks before starting treatment. Though mostly temporary, gastrointestinal side effects affect many users during the initial treatment phases. Additionally, the evidence clearly shows Wegovy works best as a long-term solution rather than a quick fix. For more information about Wegovy, its benefits, coverage options, and potential side effects, consult with your healthcare provider. They can help determine if you meet the eligibility requirements under United Healthcare’s expanded coverage.

Finally, this coverage expansion acknowledges an important medical reality – obesity requires comprehensive, sustained treatment approaches. The combination of medication with lifestyle modifications offers patients a powerful tool against a condition affecting over 42% of Americans. Therefore, as United Healthcare’s policy continues rolling out across different states and plan types throughout 2024 and 2025, we may witness a meaningful impact on both individual health outcomes and broader public health challenges related to obesity.