Does UnitedHealthcare Cover Tirzep? A Coverage Guide

Patricia Weiser, PharmD, is a licensed pharmacist with more than a decade of clinical experience.

When UnitedHealthcare does cover Tirzep, prior authorization is usually required.

A BMI of 27 or higher with a weight-related health condition, such as high cholesterol or high blood pressure

Also, coverage is not instant. Your healthcare provider will need to submit prior authorization before your plan approves (or denies) coverage.

A BMI of 30 or higher (you can check yours with this BMI calculator )

A diagnosis of moderate-to-severe OSA confirmed by a sleep study showing at least 15 breathing pauses per hour

At least one prior unsuccessful attempt to lose weight through diet

Problems using positive airway pressure (PAP) therapy or symptoms that continue despite using PAP

If Tirzep is covered, it will appear on the list. And if prior authorization is required, you’ll see a “PA” next to it. Note that “prior authorization” is paperwork your provider sends to your insurer on your behalf showing that you meet their coverage criteria for a medication.

A BMI of 30 or higher, or a BMI of 27 or higher and at least one weight-related health condition (e.g. high cholesterol, high blood pressure, sleep apnea)

If approved, the initial authorization lasts for six months. At that point, your healthcare provider will need to submit new paperwork showing that you:

Have lost at least 5% of your body weight since starting Tirzep

If your UnitedHealthcare plan covers Tirzep for sleep apnea, your prior authorization paperwork must show that you have:

Moderate-to-severe OSA with an apnea-hypopnea index (AHI) of at least 15 events per hour on either a polysomnogram or home sleep apnea test

Tried to lose weight through diet at least once before without success

Tried PAP therapy without success, or are currently using it but still experiencing symptoms of OSA

Plans to use Tirzep with a reduced-calorie diet and increased physical activity

If approved, the initial authorization lasts for six months. At that point, your healthcare provider will need to submit new paperwork showing that you have: