Prior authorization required for GLP-1 medications
Requirement does not apply to members with documentation of type 2 diabetes
Effective Jan. 1, 2024, we will require prior authorization on covered glucagon-like peptide-1 (GLP-1) receptor agonist and glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 products for members enrolled in the following UnitedHealthcare benefit plans:
Individual UnitedHealthcare® Medicare Advantage Prescription Drug and Medicare Prescription Drug plans (including D-SNP and C-SNP)
Employer Group Medicare Advantage Prescription Drug and Medicare Prescription Drug plans
What you need to know
The new prior authorization requirement is intended to confirm medically appropriate use of GLP-1s for members with type 2 diabetes.
Members with a type 2 diabetes diagnosis on their member profile with us will not require a prior authorization for a formulary GLP-1, as the prescription claim will process automatically. Members without documentation of type 2 diabetes on file with us will be required to have prior authorization approval for coverage or continued coverage on or after Jan. 1, 2024.
In December 2023, we will send prescribers a list of their patients who are currently taking a GLP-1 and will require prior authorization to continue coverage of their GLP-1 in 2024.
To prevent any potential disruption in GLP-1 therapy, please provide documentation of type 2 diabetes for your patients on or before Jan. 1, 2024. To do so, you can either:
Assess and document type 2 diabetes ICD-10 during a patient visit and submit to us
Include the type 2 diabetes ICD-10 on the prescription sent to the pharmacy