HealthRX.com · Printable coverage checklist
UnitedHealthcare Zepbound authorization and renewal record
Confirm the plan covers weight-loss drugs at all, note what the prescriber documents for the first request, record your baseline and month-6 weights for the renewal, and keep the authorization dates in one place. It follows UnitedHealthcare's program 2026 P 1114-23, effective October 1, 2026.
Check first
- Asked UnitedHealthcare or your benefits office whether your employer elected weight-loss medication coverage
- Confirmed the reason on the prescription: weight loss, or moderate to severe sleep apnea
- If weight-loss drugs are excluded and you have sleep apnea: asked whether the Nonformulary Zepbound criteria can be used
- Checked your plan's drug list for supply limits and your cost for a fill
- On a UnitedHealthcare Medicare Advantage plan: asked about the Medicare GLP-1 Bridge instead of the plan formulary
What the prescriber documents for the first request
BMI and the date it was measured
Weight-related conditionsneeded when BMI is 27 to under 30
Sleep apnea diagnosis and severity, if that is the reason
Lifestyle changes used alongside Zepbounddiet or caloric restriction, exercise, behavioral support, a community program
Weight record for the renewal
Percent change = (baseline weight - current weight) ÷ baseline weight × 100.
| Date | Weight | Change from baseline (%) | Zepbound dose | Lifestyle program notes |
|---|---|---|---|---|
| Baseline, before the first dose | ||||
| Near the end of the first authorization | ||||
UnitedHealthcare program 2026 P 1114-23 (effective October 1, 2026)
- The program is optional: it applies to clients and businesses that have chosen to cover weight-loss products.[1]
- Zepbound can be requested for weight loss or for moderate to severe obstructive sleep apnea.[1]
- A first Zepbound authorization lasts 6 months.[1]
- A renewal lasts 12 months and asks for at least 5% loss of baseline body weight plus continued lifestyle changes.[1]
- Someone not yet at a maintenance dose can get a one-time 6-month authorization to finish titrating.[1]
- Supply limits may apply to fills.[1]
If you have Medicare drug coverage
- The Medicare GLP-1 Bridge, which began July 1, 2026, includes Zepbound in the KwikPen form; single-dose Zepbound vials and pens are not included.[2]
- Through the Bridge, an eligible person pays the pharmacy $50 for a one-month supply of 28 or 30 days.[2]
Authorization dates
First authorization: start and end dates
Titration authorization, if used: start and end dates
Renewal sent on, and decision date
Reference number for each decision
Questions for UnitedHealthcare, OptumRx or the prescriber
- Does my employer's plan include weight-loss medication coverage?
- Was the request reviewed for weight loss or for sleep apnea?
- What dates does this authorization cover, and when should the renewal go in?
- Which weight will be used as my baseline for the renewal?
- If I am still increasing the dose at the renewal, will the one-time titration authorization be used?
- What will each fill cost under my plan's tier, deductible and supply limit?
Sources for the facts on this sheet
- UnitedHealthcare Pharmacy, Clinical Pharmacy Programs. Prior Authorization/Notification - Weight Loss/Appetite Suppression Medication Coverage (Program Number 2026 P 1114-23, effective October 1, 2026). Accessed 2026-10-19. https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/drugs-pharmacy/commercial/r-z/PA-Notification-Weight-Loss.pdf
- Centers for Medicare & Medicaid Services, Medicare.gov. Weight loss drugs | Medicare. Accessed 2026-10-19. https://www.medicare.gov/coverage/weight-loss-drugs
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.