Aetna is a CVS Health subsidiary. Coverage of GLP-1 medications is generally less generous than peer commercial insurers, with strict PA criteria for weight indications.
Generally covered for T2D. Typical copay $30–$100/month with PA.
Aetna applies strict PA criteria. Many plans require documented 6+ months of lifestyle modification with weight outcomes documented before approving Wegovy/Zepbound. Some plans exclude weight management entirely.
Coverage of Wegovy under CV indication is being added; PA criteria still rigorous.
Coverage of Zepbound for OSA is following standard PA pathways for the OSA indication.
Aetna PA criteria are typically: BMI ≥30 or BMI ≥27 with documented comorbidity; documented 6+ months of lifestyle modification with weight tracking; documented commitment to ongoing lifestyle.
Strict PA makes denials common; carefully prepare medical necessity documentation; appeal denials; consider cash-pay alternatives.
The most reliable way to verify coverage is to call the member services number on your insurance card and ask: (1) Is [Wegovy/Zepbound/Ozempic/Mounjaro] on my formulary? (2) What tier? (3) What are the prior authorization criteria? (4) What's my expected copay at each tier? Document the date, the rep's name, and any reference number.
If insurance coverage is unworkable, see our price index for current cash-pay compounded options. Our editor's pick, NexLife, runs $145–$215/month flat-rate.