UnitedHealthcare Mounjaro coverage appeal

UnitedHealthcare prior authorization criteria for Mounjaro

• •BMI ≥30 (or ≥27 + at least 2 comorbidities)
• •6-month lifestyle intervention
• •Step therapy with at least one anti-obesity medication

Step-by-step appeal flow

1. 1

   Pull your carrier policy bulletin

   UnitedHealthcare publishes its Mounjaro coverage criteria. Read it first — every successful appeal cites it back to the reviewer.

2. 2

   Document your medical necessity

   BMI ≥30 (or ≥27 + at least 2 comorbidities) 6-month lifestyle intervention Step therapy with at least one anti-obesity medication

3. 3

   Have your prescriber submit the PA

   Most UnitedHealthcare PAs go through CoverMyMeds or the carrier portal. Your prescriber attaches BMI history, comorbidities (with ICD-10 codes), lifestyle program participation, and prior weight-loss attempts.

4. 4

   If denied — file the appeal within 60 days

   UnitedHealthcare requires comorbidity count — list every applicable diagnosis. Reference the specific UHC policy document by drug name.

5. 5

   Submit external review if internal appeals fail

   After two internal appeals, you can request external review through your state insurance commissioner. ERISA plans go through the federal external-review process.