Does Aetna cover Zepbound? Coverage requirements and cost

In this article:

• Does Aetna cover Zepbound?
• How much does Zepbound cost?
• How to check whether your Aetna plan covers Zepbound
• What to do if your Aetna plan won’t cover Zepbound
• How to save on Zepbound

In this article

• Does Aetna cover Zepbound?
• How much does Zepbound cost?
• How to check whether your Aetna plan covers Zepbound
• What to do if your Aetna plan won’t cover Zepbound
• How to save on Zepbound

GLP-1 drugs like Ozempic might have started out as Type 2 diabetes medications, but their weight loss potential is what thrust them into the national spotlight. And Zepbound (tirzepatide) is one of the latest additions in the GLP-1 landscape, one specifically approved by the Food and Drug Administration (FDA) for chronic weight management. In clinical trials, patients taking Zepbound lost over 20% of their body weight on average. But the question many people have is: Will insurance pay for it? Some plans might, but with Aetna, Zepbound coverage ultimately depends on the plan and the patient’s reason for taking it. 

Does Aetna cover Zepbound?

Every insurance provider is different, and most have a wide range of benefits plans, each with their own policies.

Certain plans require prior authorization, which is how the insurance company confirms that a drug meets its criteria for coverage. That could mean the prescribing healthcare provider has to submit additional details showing why the drug is necessary. Or it could require a process called step therapy, which involves trying (and failing) other drugs, like metformin, phentermine, or bupropion, before moving on to Zepbound. There might also be limits on the strength of the medication or the quantity you can receive. All of that info, however, is contained in each plan’s formulary.

“I would say about 50% of the time, or more, we have to do some type of prior authorization,” estimates Supriya Rao, MD, gastroenterologist and managing partner at Integrated Gastroenterology Consultants. “And then, whether or not someone needs to try and fail another drug first is around a quarter of my patients.”

Does Aetna cover Zepbound for weight loss?

As of July 1, 2025, many Aetna standard commercial plans removed Zepbound from their formularies when prescribed for the purpose of weight management.

Aetna plans that do cover Zepbound for weight loss require patients to meet particular criteria to get coverage. Specifically, according to Aetna’s Pharmacy Clinical Policy Bulletins, patients need to:

• Undergo six months on a weight management plan that includes diet, exercise, and other behavior modification prior to taking Zepbound.
• Have a documented body mass index (BMI) of at least 30 kg/m2 OR a BMI of at least 27 kg/m2 accompanied by a diagnosis of at least one weight-related health condition, such as hypertension, Type 2 diabetes, or dyslipidemia.

Aetna requires documentation of the above criteria from the healthcare provider before covering Zepbound for weight management.

Physicians who have extra training in obesity medicine or lifestyle medicine may be specially trained to help navigate the insurance rules. “For these patients, I teach cooking classes, and I run a lifestyle medicine curriculum through my office in a group setting,” Dr. Rao says. “So if someone is coming through my curriculum, as long as they’ve seen me for six months, then we can at least say check and say ‘yes, they are already doing this.’”

Does Aetna cover Zepbound for obstructive sleep apnea?

Aetna may cover Zepbound for obstructive sleep apnea, but ultimately, coverage depends on the plan. For example, Aetna Better Health covers Zepbound for obstructive sleep apnea when used with a reduced-calorie diet and increased physical activity in patients who meet certain requirements, including a BMI of at least 30 and a moderate to severe sleep apnea severity.

How much does Zepbound cost?

Let’s say you don’t have health insurance at all, your insurance does not cover Zepbound, or you would rather pay entirely out of pocket. Without help from insurance or other sources (see below), Zebound’s average cost is around $1,522 for a pack of four 0.5 mL of 5 mg/0.5 mL pens.

The good news is that many people don’t pay that full amount, either through insurance or otherwise. But receiving insurance coverage doesn’t always mean you’ll get the drug for free. Like with other insurance companies, Aetna members are responsible for paying copays and coinsurance based on how their plan classifies Zepbound and whether they’ve met their annual deductible that year.

Formularies group medications into different tiers, and insurance companies typically pay more (or all) of the cost of the drugs in the lower tiers (generic drugs) more consistently than those in the higher tiers (brand names, specialty drugs, etc.). As a brand-name drug, Zepbound often falls somewhere in the middle, so there’s a chance that you’ll still need to pay something, even with insurance coverage. 

Dr. Rao says it’s especially important for patients to understand their plan’s rules, tiers, and prior authorization requirements before requesting a Zepbound prescription from a healthcare provider. “I think if people are really armed with that information, it makes things a lot easier. Then there are no unmet expectations,” she says.

How to check whether your Aetna plan covers Zepbound 

The plan formulary should be your go-to resource for all things prescription drug coverage. There are a few different ways to access this information:

1. Use Aetna’s member website. On this page, you can select your specific plan and year, then click the link that says “Go to [Your Plan Name].” There, you’ll find a database where you can search for Zepbound (or any other medication), along with a PDF of the complete formulary and other plan documents.
2. Log in to your member portal, where you can access your specific drug formulary. You can also find your plan documents and summary of benefits on your member portal.
3. Call Aetna directly to speak with a member support representative. Just make sure to have your insurance card and policy number on hand, since they’ll need that info to check your coverage.

What to do if your Aetna plan won’t cover Zepbound

You have options if Aetna won’t cover Zepbound. For sleep apnea, Zepbound is the only FDA-approved medication; however, your healthcare provider may recommend other treatment options.

For weight loss, there are several Zepbound alternatives, including other GLP-1s that Aetna may cover, such as Saxenda or Wegovy. They can also recommend weight-management programs that Aetna may cover and lifestyle interventions to help with weight loss. If they determine that Zepbound is the best option for you, there are ways to save.

Weight Loss Coupons & Resources

How to save on Zepbound

One of the best ways to save on Zepbound without insurance is to use SingleCare coupons, which can drop Zepbound from $1,522 to $950 instantly. All you have to do is sign up for free, then send your prescription to a partnering pharmacy. When your prescription is ready for pickup, present your SingleCare card to receive your discount at checkout.

Dr. Rao often recommends the Lilly Direct program, which allows patients to purchase medications directly from the company at a discounted rate, along with coupon codes and patient assistance programs. Eli Lilly also has a Zepbound savings card for people with partial insurance coverage, but people who have health benefits from Medicare, Medicaid, or other government-funded sources aren’t eligible.