{"id":627759,"date":"2024-04-12T13:23:31","date_gmt":"2024-04-12T17:23:31","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=627759"},"modified":"2025-12-02T14:34:43","modified_gmt":"2025-12-02T19:34:43","slug":"does-aetna-cover-wegovy","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-aetna-cover-wegovy\/","title":{"rendered":"Does Aetna cover Wegovy?"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/prescription\/wegovy\"><span style=\"font-weight: 400;\">Wegovy<\/span><\/a><span style=\"font-weight: 400;\"> (semaglutide) is an injectable medication approved by the Food and Drug Administration (FDA) for weight loss. It\u2019s 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.<\/span><\/p>\n<p><span data-sheets-root=\"1\" data-sheets-value=\"{&quot;1&quot;:2,&quot;2&quot;:&quot;&quot;}\" data-sheets-userformat=\"{&quot;2&quot;:6849,&quot;3&quot;:{&quot;1&quot;:0},&quot;9&quot;:1,&quot;10&quot;:2,&quot;12&quot;:0,&quot;14&quot;:{&quot;1&quot;:2,&quot;2&quot;:0},&quot;15&quot;:&quot;Arial&quot;}\" data-sheets-formula=\"=CONCATENATE(R[0]C[-2],R[0]C[-3],R[0]C[-1])\"><\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some Aetna health insurance plans cover Wegovy, but coverage varies by plan. We\u2019ll outline Aetna\u2019s Wegovy coverage details and explain how to check your specific plan. We\u2019ll also share ways to save on Wegovy if your plan won\u2019t cover it.<\/span><\/p>\n<h2 id=\"does-aetna-cover-wegovy\"><span style=\"font-weight: 400;\">Does Aetna cover Wegovy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Yes, some Aetna health insurance plans cover Wegovy. Conversely, some plans exclude coverage of <\/span><a href=\"https:\/\/www.aetna.com\/cpb\/medical\/data\/1_99\/0039.html#dummyLink2\"><span style=\"font-weight: 400;\">programs and supplies<\/span><\/a><span style=\"font-weight: 400;\"> for obesity, diet, and weight control\u2014including <\/span><a href=\"https:\/\/www.aetna.com\/products\/rxnonmedicare\/data\/2025%20commercial\/Antiobesity_Agents_Aetna_ONLY_for_Specific_States_PA_with_Limit_5098-C_P08-2024_R.html\"><span style=\"font-weight: 400;\">weight-reduction medications<\/span><\/a><span style=\"font-weight: 400;\"> such as Wegovy.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/wegovy-diet-plan\/\"><b>The best diet while taking Wegovy<\/b><\/a><\/p>\n<p><span style=\"font-weight: 400;\">Aetna has separate <\/span><a href=\"https:\/\/www.aetna.com\/products\/rxnonmedicare\/data\/2023\/Wegovy_PA_Policy_4774-A_08-2022_v2.html\"><span style=\"font-weight: 400;\">Wegovy coverage criteria<\/span><\/a><span style=\"font-weight: 400;\"> for adults and adolescents.\u00a0<\/span><\/p>\n<h3 id=\"aetna-s-wegovy-coverage-criteria-for-adults\"><span style=\"font-weight: 400;\">Aetna\u2019s Wegovy coverage criteria for adults<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">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 have one of the following:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A body mass index (BMI) of 30 or higher<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">A BMI of 27 or higher with at least one weight-related comorbid condition, such as high blood pressure or diabetes<\/span><\/li>\n<\/ul>\n<p><a href=\"https:\/\/informedrxllc.com\/about-us\"><span style=\"font-weight: 400;\">Christie Kunde, Pharm.D.<\/span><\/a><span style=\"font-weight: 400;\">, owner of InformedRx, has found that, in her experience, some insurance companies may cover Wegovy with no restrictions, while others require <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><span style=\"font-weight: 400;\">prior authorization<\/span><\/a><span style=\"font-weight: 400;\">. 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.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Participating Aetna plans will cover Wegovy with prior authorization for adults ages 18 years and older if they\u2019ve either:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">Completed at least three months of Wegovy at a stable maintenance dose and lost 5% of their baseline body weight,<\/span><b> or\u00a0<\/b><\/li>\n<li><span style=\"font-weight: 400;\">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:<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Have a BMI greater than or equal to 30, <\/span><b>or<\/b><\/li>\n<li><span style=\"font-weight: 400;\">Have a BMI greater than or equal to 27 and at least one weight-related comorbid condition\u00a0<\/span><\/li>\n<\/ul>\n<h3 id=\"aetna-s-wegovy-coverage-criteria-for-adolescents\"><span style=\"font-weight: 400;\">Aetna\u2019s Wegovy coverage criteria for adolescents\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The FDA approved Wegovy for adolescents ages 12\u201317 years with an<\/span><span style=\"font-weight: 400;\"> initial BMI at the 95th percentile or greater (standardized for age and sex) while following a reduced-calorie diet and increased physical activity.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">On participating Aetna plans, Wegovy is covered with prior authorization for adolescents ages 12\u201317 years who meet the FDA\u2019s criteria and have either:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Successfully adjusted to a stable maintenance dose and lowered their baseline BMI, <\/span><b>or<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">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<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">\t\t<div class=\"singlecare-dynamic-newsletter-wrapper sin-newsletter-wrapper\">\n\t\t\t<span class=\"heading\">Get our diabetes newsletter<\/span>\n\t\t\t<form class=\"form-wrapper\" data-newsletter-form=\"1\" data-subsource=\"Diabetes Newsletter\">\n\t\t\t\t<div class=\"input-wrapper\">\n\t\t\t\t\t<label for=\"dynamic-email\">Email<\/label>\n\t\t\t\t\t<input type=\"email\" id=\"dynamic-email\" class=\"email\" required>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"input-wrapper\">\n\t\t\t\t\t<input class=\"submit-form-btn\" type=\"submit\" value=\"Click to sign up\">\n\t\t\t\t<\/div>\n\t\t\t<\/form>\n\t\t\t<p class=\"success-message\" aria-live=\"polite\"><\/p>\n\t\t<\/div>\n\t<\/span><\/p>\n<h3 id=\"how-to-streamline-prior-authorization\"><span style=\"font-weight: 400;\">How to streamline prior authorization<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">You may be able to get your prescription more quickly if you can streamline the prior authorization process. <\/span><a href=\"https:\/\/www.linkedin.com\/in\/suneye-koohsari-8b9796196\/\"><span style=\"font-weight: 400;\">Suneye Koohsari, MD<\/span><\/a><span style=\"font-weight: 400;\">, owner of Manhattan Medical Weight Loss, recommends pulling together a medical history of your prior diets, weight loss programs, and medications you&#8217;ve used for weight management before seeing your healthcare provider for Wegovy.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cInclude details such as the dates you started and stopped each program or medication, their effectiveness, any side effects experienced, and reasons for discontinuation,\u201d Dr. Koohsari says. If your healthcare provider has this information readily available, prior authorization can go more quickly.\u00a0\u00a0<\/span><\/p>\n<h2 id=\"how-much-does-wegovy-cost\"><span style=\"font-weight: 400;\">How much does Wegovy cost?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Without health insurance or coupons, Wegovy typically costs $1,867 for a one-month supply (four 2.4-mg injector pens taken weekly). That price can vary greatly by pharmacy and location.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Insurance coverage and cost for Wegovy vary by Aetna plan. Contact your plan for details.<\/span><\/p>\n<h2 id=\"how-to-check-whether-your-aetna-plan-covers-wegovy\"><span style=\"font-weight: 400;\">How to check whether your Aetna plan covers Wegovy<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">You can contact <\/span><a href=\"https:\/\/www.aetna.com\/individuals-families\/member-rights-resources\/member-services.html\"><span style=\"font-weight: 400;\">Aetna member services online<\/span><\/a><span style=\"font-weight: 400;\"> or by calling the member services phone number on your insurance card to check your plan\u2019s Wegovy coverage.<\/span><\/p>\n<p><a href=\"https:\/\/www.aetna.com\/individuals-families\/find-a-medication.html\"><span style=\"font-weight: 400;\">Aetna\u2019s prescription drug coverage finder<\/span><\/a><span style=\"font-weight: 400;\"> can also help. Select your plan year and plan name. From there, you can download a PDF of your plan\u2019s pharmacy drug guide, view any guide changes made this year, or click \u201cfind medicine\u201d and type \u201cWegovy\u201d in the \u201cbrand &amp; generic name\u201d search bar.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Novo Nordisk, the manufacturer of Wegovy, has <\/span><a href=\"https:\/\/www.wegovy.com\/coverage-and-savings\/check-your-cost-and-coverage.html\"><span style=\"font-weight: 400;\">an online tool<\/span><\/a><span style=\"font-weight: 400;\"> that you can use to check your cost and coverage as well. However, since it doesn\u2019t constitute a guarantee of coverage or copay amount, it\u2019s advisable to contact Aetna directly to confirm the accuracy of coverage.<\/span><\/p>\n<p><strong>RELATED:<\/strong> <a href=\"https:\/\/www.singlecare.com\/blog\/does-aetna-cover-zepbound\/\"><b>Does Aetna cover Zepbound?<\/b><\/a><\/p>\n<h2 id=\"how-to-save-on-wegovy\"><span style=\"font-weight: 400;\">How to save on Wegovy<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If your Aetna plan doesn\u2019t cover Wegovy, you have a few options to save on the retail price.\u00a0<\/span><\/p>\n<h3 id=\"free-wegovy-coupons\"><span style=\"font-weight: 400;\">Free Wegovy coupons<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">A <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/wegovy\"><span style=\"font-weight: 400;\">SingleCare coupon for Wegovy<\/span><\/a><span style=\"font-weight: 400;\"> can lower the cost of the drug by close to $600 for a month\u2019s supply, depending on the pharmacy you choose. Novo Nordisk also offers <\/span><a href=\"https:\/\/www.wegovy.com\/coverage-and-savings\/save-on-wegovy.html\"><span style=\"font-weight: 400;\">Wegovy coupons and savings programs<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<h2 id=\"if-aetna-doesn-t-cover-wegovy\"><span style=\"font-weight: 400;\">If Aetna doesn\u2019t cover Wegovy<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The Wegovy website offers a guide to <\/span><a href=\"https:\/\/www.wegovy.com\/coverage-and-savings\/wegovy-coverage-options.html\"><span style=\"font-weight: 400;\">gaining insurance coverage for Wegovy<\/span><\/a><span style=\"font-weight: 400;\">. The guide includes a sample letter your healthcare provider can use to submit a coverage request to your insurance company. It also offers tips for those with Medicaid, VA benefits, Tricare, or government-sponsored insurance.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/wegovy-vs-phentermine\/\"><b>Wegovy vs. phentermine: Differences, similarities &amp; side effects<\/b><\/a><\/p>\n<p><small>The SingleCare prices in this article are the most accurate at the time of publishing in ZIP code 23666 as of 12\/02\/2025. Prices vary by pharmacy. Visit our Wegovy coupon page for updated prices near you.<\/small><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Wegovy (semaglutide) is an injectable medication approved by the Food and Drug Administration (FDA) for weight loss. It\u2019s 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 [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":627760,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[21067,608,9825],"coauthors":[8861],"class_list":["post-627759","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-glp-1-drugs","tag-health-insurance","tag-weight-loss","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Does Aetna cover Wegovy?<\/title>\n<meta name=\"description\" content=\"Aetna may cover Wegovy for members who meet its coverage criteria, but coverage varies by plan.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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