Does Aetna Cover Wegovy? Criteria, Copay, How to Appeal
Aetna covers Wegovy for weight loss only when your employer or plan has added weight-loss drugs. Where it is covered, you need a BMI of 30, or 27 with a weight-related condition.
- For weight loss
- Employer option
- For type 2 diabetes
- Covered on formulary
- Prior authorization
- Required
- Weight rule
- A BMI of 30, or 27 with a weight-related condition
- Self-pay if denied
- $149 a month
Wegovy overview
Its half-life is about 1 week. After 7 d, half is gone. Five half-lives (35 d) leave about 3%.
In STEP 1 over 68 weeks, people lost 14.9% of body weight, compared with 2.4% on placebo.
Monthly price points are listed in US dollars. They include list prices and self-pay offers, with each one taken from the manufacturer's price page.
Sources: FDA label (DailyMed), healthsystemtracker.org, prnewswire.com 1 2.
Does Aetna cover Wegovy?
| Medicine | Approved for | Status | Prior authorization |
|---|---|---|---|
| Wegovy | Weight loss, heart risk and MASH liver disease | Employer option | Required |
Sources: TrumpRx, NovoCare, CMS, medicare.gov.
The published policy
Aetna is a commercial insurer (CVS Health)
- The plan sponsor makes the choice
Read the policy yourself at aetna.com.
Source: aetna.com.
Prior authorization checklist
- Your chart lists the weight diagnosis your plan asks for, or heart risk and MASH liver disease, another approved use of Wegovy.
- Weight rule: your baseline must be BMI 30 or higher
- The lower weight rule requires BMI 27 or higher with a weight-related condition
- Lifestyle program first: the first step is a weight program lasting 6 months
- To renew coverage, lose 5% of your baseline weight
- Records: include the diet and activity program you tried, your measured height and weight, and any weight-related conditions.
- Who sends it: your prescriber files the prior authorization, not you.
Source: aetna.com.
If you are turned down: the appeal
| Denial reason | What to send or ask |
|---|---|
| The plan excludes weight-loss drugs | This is a plan design choice. Ask your employer's benefits team if the plan will add weight-loss drugs when it renews. |
| Criteria not met | Ask your prescriber to file again with the measured BMI (per the rule, a BMI of 30, or 27 with a weight-related condition) plus each weight-related condition listed in your chart. |
| No lifestyle program on file | First, send records that document a weight program of 6 months. |
| Renewal denied | Send your starting and current weight. Renewal requires that you have lost 5% of your baseline weight. |
| The drug is not on the plan's list | Request a formulary exception, and ask which GLP-1 medicines your plan prefers instead. |
- Get the denial letter; it points to the exact rule not met.
- Include chart notes that address that rule with the appeal filed by your prescriber.
- If the plan's own appeal fails, request an outside review by an independent reviewer instead.
Source: aetna.com.
State and plan differences
| Plan | For weight loss | Prior authorization |
|---|---|---|
| Medicare | Bridge program only | Required |
| Medicaid | Varies by state | Required |
 Cigna (Evernorth / Express Scripts) | Plan dependent | Required |
 UnitedHealthcare (Optum Rx) | Plan dependent | Required |
 Blue Cross Blue Shield | Plan dependent | Required |
 Kaiser Permanente | Plan dependent | Required |
 CVS Caremark | Plan sponsor choice | Required |
| VA (Veterans Health Administration) | Covered with criteria | Required |
 GEHA | Covered with PA | Required |
 Ambetter (Centene) | Excluded | Required |
| Express Scripts | Plan sponsor choice | Required |
| Optum Rx | Plan sponsor choice | Required |
 Humana | Bridge program only | Required |
| TRICARE | Prime and Select only | Required |
| ACA Marketplace plans | Rare | Required |
 Navitus | Plan sponsor choice | Not listed |
 Amerigroup (Elevance Medicaid) | Follows state Medicaid | Required |
State Medicaid rules vary. Right now, GLP-1s for weight loss have coverage in 10 states. See every state
Other options when coverage says no
| Route | Who it is for | What you pay |
|---|---|---|
| NovoCare Pharmacy: Wegovy pill 1.5 mg | Self-pay, no insurance needed | $149 a month |
| TrumpRx listing (pill, starting) | Self-pay only, not with insurance | $149 a month |
Prices checked November 2026. Each one links to the page where it comes from.
Sources: TrumpRx, NovoCare, CMS, medicare.gov.