Are you struggling to lose weight and considering seeking medical assistance? With the growing prevalence of obesity, many health insurance providers, including United Healthcare, offer coverage for weight loss medications. But what exactly does United Healthcare cover, and what are the requirements for coverage? In this article, we’ll delve into the world of weight loss medications and explore what United Healthcare has to offer.
Understanding Weight Loss Medications
Before we dive into what United Healthcare covers, let’s take a step back and understand the different types of weight loss medications available. Prescription weight loss medications are designed to help individuals with a body mass index (BMI) of 30 or higher, or those with a BMI of 27 or higher who have at least one weight-related condition, such as high blood pressure or type 2 diabetes.
There are several types of weight loss medications, including:
- Appetite suppressants: These medications, such as phentermine, work by reducing hunger and increasing feelings of fullness.
- Fat absorbers: Medications like orlistat (Alli) work by reducing the absorption of fat in the body.
- Metabolic boosters: Medications like Qsymia and Contrave work by increasing metabolism and energy levels.
United Healthcare’s Coverage Policy
United Healthcare, one of the largest health insurance providers in the United States, offers coverage for certain weight loss medications. However, the specific coverage policy varies depending on the type of plan and the member’s individual needs.
In general, United Healthcare requires that members meet certain criteria before coverage is approved. These criteria may include:
- BMI requirements: Members must have a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related condition.
- Diet and exercise attempts: Members must have attempted to lose weight through diet and exercise for at least three months prior to seeking medication.
- Medical necessity: Members must have a medical necessity for the medication, such as a weight-related condition that puts their health at risk.
Covered Medications
United Healthcare covers a range of weight loss medications, including:
- Phentermine (Adipex-P): A popular appetite suppressant that is often prescribed for short-term use.
- Orlistat (Alli): A fat absorber that is available over-the-counter, but may be covered by United Healthcare with a prescription.
- Qsymia: A combination medication that consists of phentermine and topiramate, which works to reduce hunger and increase feelings of fullness.
- Contrave: A combination medication that consists of bupropion and naltrexone, which works to increase metabolism and energy levels.
Exceptions and Limitations
While United Healthcare covers these medications, there are some exceptions and limitations to be aware of. For example:
- Prior authorization: Members may need to obtain prior authorization from their healthcare provider before the medication is covered.
- Step therapy: United Healthcare may require members to try a lower-cost medication before covering a more expensive one.
- Quantity limits: United Healthcare may limit the quantity of medication that is covered per prescription.
Cost and Copays
The cost of weight loss medications can vary depending on the specific medication, dosage, and pharmacy. United Healthcare members may be responsible for a copay or coinsurance for their prescription, which can range from $20 to $100 or more per month.
| Medication | Average Copay |
|---|---|
| Phentermine (Adipex-P) | $20-$30 |
| Orlistat (Alli) | $10-$20 |
| Qsymia | $50-$70 |
| Contrave | $60-$80 |
Additional Resources and Programs
In addition to covering weight loss medications, United Healthcare offers a range of resources and programs to support members on their weight loss journey. These may include:
- Dietitian services: Many United Healthcare plans offer access to registered dietitians who can provide personalized nutrition counseling.
- Wellness programs: United Healthcare offers a range of wellness programs, including fitness classes, weight loss support groups, and healthy living resources.
- Telehealth services: Some United Healthcare plans offer telehealth services, which allow members to consult with healthcare providers remotely.
Takeaway
Losing weight can be a challenging and frustrating experience, but with the right support and resources, it can be achievable. United Healthcare’s coverage of weight loss medications can be a valuable tool for members who are struggling to lose weight and improve their overall health. By understanding what medications are covered and what the requirements are, members can make informed decisions about their healthcare.
Remember, weight loss medications are not a quick fix, but rather a tool to be used in conjunction with a healthy diet and regular exercise. By combining medication with lifestyle changes, individuals can achieve sustainable weight loss and improve their overall health and wellbeing.
What is United Healthcare’s policy on covering weight loss medications?
United Healthcare’s policy on covering weight loss medications varies depending on the specific plan and the individual’s health needs. In general, United Healthcare covers weight loss medications that are FDA-approved and medically necessary for the treatment of obesity or weight-related health conditions. However, the coverage may depend on the specific medication, the individual’s health status, and the prescribing doctor’s recommendation.
It’s essential to review your policy documents or consult with your healthcare provider to determine which weight loss medications are covered under your plan. Additionally, United Healthcare may require prior authorization or have specific criteria for coverage, so it’s crucial to understand the requirements and limitations of your plan.
Does United Healthcare cover prescription medications like Xenical and Saxenda?
Yes, United Healthcare may cover prescription medications like Xenical (orlistat) and Saxenda (liraglutide) for weight loss, depending on the specific plan and the individual’s health needs. These medications are FDA-approved for weight loss and are commonly prescribed for individuals with obesity or related health conditions. However, coverage may vary depending on the plan’s formulary and the individual’s medical history.
To confirm coverage, you should review your policy documents or consult with your healthcare provider. You may also need to meet specific criteria, such as having a BMI of 30 or higher, or having at least one weight-related health condition, such as diabetes or high blood pressure.
Are over-the-counter (OTC) weight loss medications covered by United Healthcare?
No, United Healthcare does not typically cover over-the-counter (OTC) weight loss medications, as they are not prescription medications and are not considered medically necessary. However, some OTC medications, such as Alli (orlistat), may be covered under certain circumstances, such as if they are prescribed by a doctor for a specific medical condition.
It’s essential to review your policy documents to understand what is covered and what is not. If you have questions about coverage, you should consult with your healthcare provider or contact United Healthcare’s customer service.
Can I get coverage for weight loss medications if I have a BMI below 30?
Typically, United Healthcare’s coverage for weight loss medications is limited to individuals with a BMI of 30 or higher, or those with a BMI of 27 or higher with at least one weight-related health condition, such as diabetes or high blood pressure. However, some plans may have different criteria for coverage, so it’s essential to review your policy documents to understand the specific requirements.
If you have a BMI below 30, you may not be eligible for coverage for weight loss medications under your United Healthcare plan. However, you should consult with your healthcare provider to discuss alternative treatment options and develop a personalized weight loss plan.
How do I get prior authorization for a weight loss medication?
To get prior authorization for a weight loss medication, you should first consult with your healthcare provider to determine if the medication is medically necessary for your specific health needs. Your doctor will need to submit a prior authorization request to United Healthcare, along with medical records and other supporting documentation.
The prior authorization process typically takes a few days to a week, depending on the complexity of the request. If approved, United Healthcare will notify you and your healthcare provider, and the medication will be covered under your plan. If denied, you can appeal the decision or explore alternative treatment options with your doctor.
Can I get coverage for weight loss medications if I have a history of eating disorders?
United Healthcare’s coverage for weight loss medications may be affected if you have a history of eating disorders, such as anorexia nervosa or bulimia nervosa. In some cases, certain weight loss medications may not be appropriate for individuals with a history of eating disorders, as they can exacerbate the condition.
You should consult with your healthcare provider and a mental health professional to discuss your individual needs and develop a personalized treatment plan. United Healthcare may require additional documentation or assessments to determine coverage for weight loss medications in these cases.
How much do weight loss medications cost under United Healthcare?
The cost of weight loss medications under United Healthcare varies depending on the specific plan, the individual’s health needs, and the medication itself. Some plans may have a copayment or coinsurance for prescription medications, while others may require a deductible or have other out-of-pocket costs.
You should review your policy documents or consult with your healthcare provider to understand the costs associated with weight loss medications under your United Healthcare plan. Additionally, you may be able to reduce your out-of-pocket costs by using a mail-order pharmacy or exploring alternative treatment options.