Does Aetna cover Qsymia?

In this article:

• Does Aetna cover Qsymia?
• How much is Qsymia without insurance?
• How much does Qsymia cost with Aetna?
• How to check whether your Aetna plan covers Qsymia
• How to save on Qsymia

In this article

• Does Aetna cover Qsymia?
• How much is Qsymia without insurance?
• How much does Qsymia cost with Aetna?
• How to check whether your Aetna plan covers Qsymia
• How to save on Qsymia

Obesity is widespread in the U.S. and around the world, and Qsymia (phentermine-topiramate) is a brand-name prescription drug that can help treat it. Alongside diet and exercise, it’s approved for weight management in adults or children 12 years and older. A lot of insurance plans—including many Aetna plans—will cover it, but there are still a lot of factors to consider when determining your out-of-pocket expenses. Below, we’ve got everything you need to know about Aetna insurance coverage for Qsymia. 

Does Aetna cover Qsymia?

Some Aetna plans cover Qsymia, while others don’t. Qsymia’s website says it’s covered by “a majority of commercial healthcare plans,” and many of Aetna’s formularies—lists that show how the plan classifies and covers various medications—list it as a preferred brand. That means they will likely cover it to some degree, but coverage varies. For example, the 2025 New Jersey Educators Health Plan doesn’t list Qsymia on its formulary, but the 2025 Aetna Standard Plan does, and even lists it as a preferred drug. 

Most insurance companies will only cover Qsymia if it’s prescribed for a purpose approved by the Food and Drug Administration (FDA). As Qsymia’s label states, it’s approved for weight management in:

• Adults and pediatric patients aged 12 years and older with obesity 
• Adults who are overweight with at least one weight-related comorbid condition

Some healthcare providers might prescribe Qsymia outside of those parameters, and in these cases, insurance companies might choose not to cover it.

Additionally, “prior authorization is required with most insurers,” says Jennifer Warren, MD, medical director at Mochi Health. “Requirements may include documentation of medical necessity, including BMI and comorbid conditions, proof or statement of a trial of lifestyle modification, or documentation that other medications were ineffective or contraindicated.” This is true with Aetna’s prior authorization policy for Qsymia, which also enforces quantity limits since phentermine is a controlled substance.

Aetna Medicare plans don’t cover weight loss drugs like Qsymia. Medicaid coverage for Qsymia varies by state.  

How much is Qsymia without insurance?

Without insurance coverage or any other discounts, Qsymia costs an average of $311 for 30, 7.5-46 mg capsules. That’s not as pricey as some other weight loss drugs, but it’s still not pocket change. And over an entire year, it can add up to over $3,000.

That price, however, is just an average, and it can vary based on several factors. For example, each pharmacy has different prices, and your location can influence pricing, too. So the price you pay might be lower or higher than that amount.

How much does Qsymia cost with Aetna?

Since every insurance plan differs, the amount you end up paying will vary. While some drug plans have tiers, some determine how much you’ll pay by the type of drug. For example, the Aetna Advanced Control Plan considers Qsymia a preferred brand, which is a slightly higher cost than preferred generics but less expensive than non-preferred brand and generic drugs. It’s best to check your specific plan’s formulary for an exact idea of how much you can expect to pay.

How to check whether your Aetna plan covers Qsymia 

Everything you need to know about your plan’s Qsymia coverage is in the formulary, and there are a few different ways to access it:

• Aetna’s website: Aetna has an online tool you can use to access your plan’s formulary. On this page, scroll down and select your plan from the dropdown boxes. Then, on the next page, click the link under “pharmacy drug guides,” and it will open a document where you can scroll through to find Qsymia.
• Member account: If you log into your member account on Aetna’s website, you can search for specific drugs to see how your plan covers them. Plus, it will give you price estimates for local pharmacies and generic alternatives if you’d like them.
• Member support: You can also contact Aetna by calling the phone number on your member ID card. A support representative will be able to answer your questions and potentially check the formulary for you.

“I advise patients to be proactive,” Dr. Warren says. “Verify coverage early. Patients can contact their insurer to confirm whether Qsymia is covered, what criteria apply, and what documentation is needed. If prior authorization is required, I can start the process right away.”

How to save on Qsymia

Aetna’s health insurance plans can provide significant savings on Qsymia, but there are other ways to reduce your out-of-pocket costs. Here are a few:

Free Qsymia coupons

The best way to save on Qsymia without relying on insurance is to use your free SingleCare card. By signing up and presenting your SingleCare discount card at a participating pharmacy, you may pay as little as $167 for a month’s supply of Qsymia instead of the average $311, depending on your location and choice of pharmacy. If you opt for the generic form of Qsymia, phentermine-topiramate, you may pay as little as $79. You can’t use SingleCare discounts on top of your insurance coverage, but you may pay less with your SingleCare discount than you would with insurance.

Qsymia savings card

Qsymia’s manufacturer offers a savings card, but it has limitations. For example, you can’t receive benefits from any government-sponsored programs like Medicare, Medicaid, TRICARE, or the VA. You can only use Qsymia-certified pharmacies, and you can’t seek reimbursement through flexible spending accounts (FSAs), health savings accounts (HSAs), or health reimbursement accounts (HRAs). 

The Qsymia savings card will cover up to $65 for commercially insured patients and up to $75 for uninsured patients—but patients have to cover the first $70 of the copay. With an average retail price of $311, you’ll likely save more by using your SingleCare card to pay for Qsymia.

Consider generic and alternative medications

Qsymia hasn’t cornered the market on weight loss, and some other drugs might be less expensive, or covered better by your insurance plan. Generic phentermine-topiramate was approved by the FDA in June 2024 and launched in the U.S. in May 2025 by Teva Pharmaceuticals. Dr. Warren advises patients to “opt for generic phentermine/topiramate when appropriate.” 

Additionally, “Since generics are significantly less expensive, providers may prescribe separate generic phentermine plus topiramate ER, or the combined generic product, depending on cost and formulary status,” Dr. Warren says. In fact, with SingleCare coupons, phentermine can cost as little as $10. 

RELATED: Qsymia vs. phentermine

Other common alternatives include Contrave (naltrexone/bupropion), Xenical (orlistat), and, for people with Type 2 diabetes, metformin or Ozempic, which may be more likely to be covered by insurance. Your healthcare provider can help you determine which might be viable for you. 

Compare prices

Drug prices are the product of multiple variables, and that includes the specific pharmacy and location. So it might be worth the time to check with multiple local pharmacies to see what your out-of-pocket cost might be. The SingleCare website and app make it easy to compare prices at local pharmacies. If you find a lower price at a pharmacy other than the one your prescription was sent to, pharmacy staff can easily transfer it so you can save.

Weight Loss Coupons & Resources