{"id":631986,"date":"2025-04-17T19:39:32","date_gmt":"2025-04-17T23:39:32","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=631986"},"modified":"2025-04-17T19:39:32","modified_gmt":"2025-04-17T23:39:32","slug":"does-aetna-cover-saxenda","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-aetna-cover-saxenda\/","title":{"rendered":"Does Aetna cover Saxenda?"},"content":{"rendered":"

Saxenda<\/span><\/a> (<\/span>liraglutide<\/span>) is a <\/span>brand-name<\/span> glucagon-like peptide-1<\/span> (<\/span>GLP-1<\/span>) agonist<\/span><\/a> made by the pharmaceutical company <\/span>Novo Nordisk<\/span>. It is approved by the U.S. Food and Drug Administration (FDA) for <\/span>chronic weight management<\/span><\/a> in adults with a starting, or <\/span>baseline<\/span>, <\/span>body mass index<\/span> (<\/span>BMI<\/span>) of 30 or more (<\/span>obesity<\/span>). It can also be used in adults with a starting <\/span>BMI<\/span> of 27 or more (overweight) with at least one <\/span>weight-related<\/span> health condition, such as <\/span>high blood pressure<\/span><\/a>, <\/span>Type 2 diabetes<\/span><\/a>, or <\/span>dyslipidemia<\/span> (<\/span>high cholesterol<\/span><\/a>). <\/span>Saxenda<\/span><\/a> can also be used in <\/span>pediatric<\/span> patients 12 years and older who weigh more than 132 pounds and have a starting <\/span>BMI<\/span> corresponding to 30 in adults (<\/span>obesity<\/span><\/a>). If you are considering using <\/span>Saxenda<\/span><\/a> to reduce <\/span>body weight<\/span>, you will want to know if your <\/span>Aetna<\/span> insurance plan<\/span> covers this medicine. The short answer is that it depends on your specific plan, but it may be covered with <\/span>prior authorization<\/span><\/a> if you meet certain criteria.\u00a0<\/span><\/p>\n

Does <\/span>Aetna<\/span> cover <\/span>Saxenda<\/span>?<\/span><\/h2>\n

Aetna<\/span> coverage for <\/span>Saxenda<\/span> varies by plan. Some <\/span>Aetna<\/span> plans provide coverage for <\/span>Saxenda<\/span>, and the drug may need <\/span>prior authorization<\/span>. On the other hand, some <\/span>Aetna<\/span> plans <\/span>do not cover<\/span><\/a> weight loss<\/span> 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 <\/span>weight loss<\/span> drug coverage<\/span>, and specifically, <\/span>Saxenda<\/span>.<\/span><\/p>\n

Pediatric<\/span> patients ages 12 to under 18<\/span><\/h3>\n

Saxenda<\/span> may be approved for <\/span>pediatric<\/span> patients<\/span><\/a> 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, <\/span>pediatric<\/span> patients approved for <\/span>Saxenda<\/span> must weigh more than 132 pounds and have a starting <\/span>BMI<\/span> corresponding to 30 or more for adults, which is classified as <\/span>obesity<\/span>. There are also criteria used to approve the continuation of therapy, such as losing and maintaining at least one percent of the initial <\/span>BMI<\/span> after a certain period of time.\u00a0<\/span><\/p>\n

Adult patients 18 years and older<\/span><\/h3>\n

For <\/span>adults<\/span><\/a>, <\/span>Aetna<\/span> may approve <\/span>Saxenda<\/span> for coverage if certain criteria are met, including:<\/span><\/p>\n