Does Aetna cover Saxenda?

In this article:

• Does Aetna cover Saxenda?
• How to get approved
• How much does Saxenda cost?
• How to check your coverage
• How to save

In this article

• Does Aetna cover Saxenda?
• How to get approved
• How much does Saxenda cost?
• How to check your coverage
• How to save

Saxenda (liraglutide) is a brand-name glucagon-like peptide-1 (GLP-1) agonist made by the pharmaceutical company Novo Nordisk. It is approved by the U.S. Food and Drug Administration (FDA) for chronic weight management in adults with a starting, or baseline, body mass index (BMI) of 30 or more (obesity). It can also be used in adults with a starting BMI of 27 or more (overweight) with at least one weight-related health condition, such as high blood pressure, Type 2 diabetes, or dyslipidemia (high cholesterol). Saxenda can also be used in pediatric patients 12 years and older who weigh more than 132 pounds and have a starting BMI corresponding to 30 in adults (obesity). If you are considering using Saxenda to reduce body weight, you will want to know if your Aetna insurance plan covers this medicine. The short answer is that it depends on your specific plan, but it may be covered with prior authorization if you meet certain criteria. 

Does Aetna cover Saxenda?

Aetna coverage for Saxenda varies by plan. Some Aetna plans provide coverage for Saxenda, and the drug may need prior authorization. On the other hand, some Aetna plans do not cover weight loss medications at all, even if the patient meets the criteria for use of the drug. You can contact your specific plan for more information about weight loss drug coverage, and specifically, Saxenda.

Pediatric patients ages 12 to under 18

Saxenda may be approved for pediatric patients aged 12 and older if they meet specific criteria, including being the appropriate age and having no medical reasons that would prevent them from using the medication. Additionally, pediatric patients approved for Saxenda must weigh more than 132 pounds and have a starting BMI corresponding to 30 or more for adults, which is classified as obesity. There are also criteria used to approve the continuation of therapy, such as losing and maintaining at least one percent of the initial BMI after a certain period of time. 

Adult patients 18 years and older

For adults, Aetna may approve Saxenda for coverage if certain criteria are met, including:

• Active participation in a weight management program which includes a reduced-calorie diet and exercise
• Age 18 or older, with an FDA-approved indication
• Use of only one weight loss drug at a time
• No contraindications for using Saxenda

Additionally, the patient must meet one of the following criteria:

• Diagnosis of morbid obesity (BMI of 40 or more); or
• Diagnosis of morbid obesity with a BMI of 35 or more, along with one or more weight-related medical conditions such as cardiovascular disease, hypertension (high blood pressure), high cholesterol, Type 2 diabetes, or sleep apnea 

There are also criteria to approve continuation of treatment in adults, such as losing and maintaining at least four percent from the baseline weight after 16 weeks at a maintenance dose.

Coverage and plan details can change at any time, and a prior authorization is typically needed for coverage. To find out the most recent coverage information for your specific plan, you can verify details with your insurance plan or healthcare provider.

How to get approved for Saxenda

Once you decide to start Saxenda as part of your weight loss journey, you may be excited to start the medicine and see results. However, it may take some time. Your healthcare provider will send a prescription to your preferred pharmacy (or you can bring it to your pharmacy). The pharmacy staff will process your prescription to check for insurance coverage. From here, one of three scenarios typically occur:

• Your medication is covered, and you can start your prescription fairly quickly (possibly pending a day or two for the pharmacy to order the medicine if it’s not in stock).
• Your medicine requires prior authorization. Your healthcare provider must submit documentation to your insurance company explaining why the drug is a medical necessity. It may take several days for the plan to approve or deny coverage. 
• Your plan does not cover Saxenda at all. This may occur if weight loss drugs are considered formulary exclusions. If this happens, though, there are savings options that you can discuss with your healthcare provider or pharmacist. There are also alternative treatments to consider for weight loss or Type 2 diabetes, such as using generic liraglutide (generic Victoza) off-label for weight loss. (While Saxenda does not have an FDA-approved generic, liraglutide is the active ingredient in both Saxenda and Victoza.) Other options include medications like Ozempic (semaglutide), metformin, Qsymia (phentermine/topiramate), or Contrave (naltrexone/bupropion), one of which may be prescribed depending on your specific health needs and goals.

How much does Saxenda cost?

If your insurance covers Saxenda, the copay or coinsurance may vary based on factors such as your deductible or other coverage details. It’s always best to check with your plan for the most up-to-date coverage and cost information. 

For those paying without insurance, the out-of-pocket price for a box of five, 18 mg pens is about $1,803. You can use a SingleCare discount to pay as low as $1,197, saving more than $600 every time you fill your prescription. A box of five pens would last about 30 days if you take the maximum dose of 3 mg once daily.

How to check whether your Aetna plan covers Saxenda 

To find out if your plan covers Saxenda, there are a few options:

• Check the official Saxenda website to learn more about your insurance coverage. It includes a tool to help you check if your Aetna plan covers the medicine. You can also find other resources, such as help with prior authorization requests. 
• Call your insurance plan directly to find out more about Saxenda’s costs and coverage. You can also contact Aetna’s member services department for this information. Be sure to have your information, such as your member ID and group number, ready when you call.
• Ask your healthcare provider to send the prescription to your pharmacy. Once the prescription is submitted through your plan, the pharmacy can notify you of your coverage and costs. If prior authorization is needed, the pharmacy can typically send the healthcare provider a request, and the provider can contact your plan. 

How to save on Saxenda

You can always use a free SingleCare discount to save money on your Saxenda prescription. What’s more, you can use the discount every month to save on your refills, too. You can also explore other ways to save on weight-loss medications here.