Does Aetna cover Wegovy? (2024)

Wegovy (semaglutide) is an injectable medication approved by the Food and Drug Administration (FDA) for weight loss. It’s self-administered weekly and intended to complement a reduced-calorie diet and exercise. According to clinical trials, people taking semaglutide (the active ingredient in Wegovy) experienced an average of a 15% reduction in body weight over 68 weeks.

Some Aetna health insurance plans cover Wegovy, but coverage varies by plan. We’ll outline Aetna’s Wegovy coverage details and explain how to check your specific plan. We’ll also share ways to save on Wegovy if your plan won’t cover it.

Does Aetna cover Wegovy?

Yes, some Aetna health insurance plans cover Wegovy. Conversely, some plans exclude coverage of programs and supplies for obesity, diet, and weight control—including weight reduction medications such as Wegovy.

RELATED: The best diet while taking Wegovy

Aetna has separate Wegovy coverage criteria for adults and adolescents.

Aetna’s Wegovy coverage criteria for adults

Aetna follows FDA-approved indications for Wegovy prescriptions. So, adults with an Aetna plan that covers Wegovy must take the drug in conjunction with a reduced-calorie diet and increased physical activity for chronic weight management. They must also either:

• Have a body mass index (BMI) of 30 or higher, or
• Have a BMI of 27 or higher with at least one weight-related comorbid condition, such as high blood pressure or diabetes.

Christie Kunde, Pharm.D., owner of InformedRx, has found that, in her experience, some insurance companies may cover Wegovy with no restrictions, while others require prior authorization. In other words, they want to make sure a particular treatment is medically necessary for you. Prior authorization criteria vary, and it typically occurs behind the scenes between the prescribing healthcare provider and the insurance company.

Participating Aetna plans will cover Wegovy with prior authorization for adults ages 18 and older if they’ve either:

• Completed at least three months of Wegovy at a stable maintenance dose and lost 5% of their baseline body weight, or

• Participated in a comprehensive weight management program that encourages behavioral modification, reduced-calorie diet, and increased physical activity for at least six months prior to using drug therapy, and:

• • Have a BMI greater than or equal to 30, or

• • Have a BMI greater than or equal to 27 and at least one weight-related comorbid condition

Aetna’s Wegovy coverage criteria for adolescents

The FDA approved Wegovy for adolescents ages 12–17 with an initial BMI at the 95th percentile or greater (standardized for age and sex) while following a reduced-calorie diet and increased physical activity.

On participating Aetna plans, Wegovy is covered with prior authorization for adolescents ages 12–17 who meet the FDA’s criteria and:

1. Have successfully adjusted to a stable maintenance dose and lowered their baseline BMI, or
2. Have participated in a comprehensive weight management program that encourages behavioral modification, reduced-calorie diet, and increased physical activity for at least six months prior to using drug therapy.

How to streamline prior authorization

You may be able to get your prescription more quickly if you can streamline the prior authorization process. Suneye Koohsari, MD, owner of Manhattan Medical Weight Loss, recommends pulling together a medical history of your prior diets, weight loss programs, and medications you’ve used for weight management before seeing your healthcare provider for Wegovy.

“Include details such as the dates you started and stopped each program or medication, their effectiveness, any side effects experienced, and reasons for discontinuation,” Koohsari says. If your healthcare provider has this information readily available, prior authorization can go more quickly.

How much does Wegovy cost?

Without health insurance or coupons, Wegovy typically costs $1,833 for a one-month supply (four 2.4-mg injector pens taken weekly). That price can vary greatly by pharmacy and location.

Insurance coverage and cost for Wegovy vary by Aetna plan. Contact your plan administrator for details.

How to check whether your Aetna plan covers Wegovy

You can contact Aetna member services online or by calling the member services phone number on your insurance card to check your plan’s Wegovy coverage.

Aetna’s prescription drug coverage finder can also help. Select your plan year and plan name, and click “View plan” below the dropdown menus. From there, you can download a PDF of your plan’s pharmacy drug guide, view any guide changes made this year, or click “Find a covered drug” and type “Wegovy” in the “Brand & Generic Name” search bar.

Novo Nordisk, the manufacturer of Wegovy, has an online tool that you can use to check your cost and coverage as well. But since it doesn’t constitute a guarantee of coverage or copay amount, it’s advisable to contact Aetna directly to confirm the accuracy of coverage.

How to save on Wegovy

If your Aetna plan doesn’t cover Wegovy, you have a few options to save on the retail price.

Free Wegovy coupons

A SingleCare coupon for Wegovy can lower the cost of the drug by close to $600 for a month’s supply, depending on the pharmacy you choose. Novo Nordisk also offers Wegovy coupons and savings programs. Eligible individuals with insurance can get Wegovy for free. If your Aetna plan doesn’t cover Wegovy, you can save $500 per 28-day supply (1 box).

If Aetna doesn’t cover Wegovy

The Wegovy website offers a guide to gaining insurance coverage for Wegovy. The guide includes a sample letter your healthcare provider can use to submit a coverage request to your insurance company. The guide also offers tips for those with Medicaid, VA benefits, Tricare, or government-sponsored insurance.

You may also want to consider speaking with your healthcare provider about Wegovy alternatives for weight loss. Your healthcare provider can help determine which medications or lifestyle changes (e.g., a reduced-calorie diet and physical activity) will work best for you.