{"id":632519,"date":"2025-06-10T13:34:45","date_gmt":"2025-06-10T17:34:45","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=632519"},"modified":"2026-06-05T13:18:35","modified_gmt":"2026-06-05T17:18:35","slug":"is-contrave-covered-by-aetna","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/is-contrave-covered-by-aetna\/","title":{"rendered":"Does Aetna cover Contrave?"},"content":{"rendered":"

Some Aetna commercial plans may cover <\/span>Contrave<\/span><\/a>, but it\u2019ll typically be on a non-preferred tier, which means it\u2019ll cost more than generics or other alternatives. It\u2019ll also likely need prior authorization, or documentation from your healthcare provider that it\u2019s medically necessary, before it\u2019s covered. Aetna Medicare plans and most state Medicaid plans won\u2019t cover Contrave or other weight-loss drugs, so whether you get coverage depends on which Aetna plan you have and whether your healthcare provider can document why Contrave is right for you.<\/span><\/p>\n

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

Sometimes, but not always. \u201cInsurance coverage for Contrave depends entirely on each individual patient\u2019s insurance plan,\u201d says Dr. Jennifer Brown, MD, a medical writer for MyObesityTeam. \u201cMedicare and most state Medicaid plans don\u2019t cover any weight loss medications, including Contrave.\u201d So, it\u2019s not incredibly likely that any specific Aetna plan will cover Contrave, but it\u2019s not impossible either. Some plans will, in fact, provide coverage. It\u2019s all based on a few different variables.\u00a0<\/span><\/p>\n

Formulary<\/span><\/h3>\n

Every insurance plan has a long document that shows how it covers each prescription medicine, called a <\/span>formulary<\/span><\/a>. Aetna plans will typically classify drugs into <\/span>multiple tiers<\/span><\/a>, including generic, preferred brand, non-preferred brand, preferred specialty, non-preferred specialty, and non-formulary. The plan is likely to cover generic and preferred drugs, but not non-formulary drugs.\u00a0<\/span><\/p>\n

Aetna\u2019s many fo documents show that Contrave (when it\u2019s listed) often falls under non-preferred brands. Just because it\u2019s non-preferred doesn\u2019t mean it\u2019ll never be covered. It might just take some extra steps, or the coverage might not be as comprehensive as for a preferred or generic drug.\u00a0<\/span><\/p>\n

Medical Condition<\/span><\/h3>\n

Contrave is <\/span>FDA-approved<\/span><\/a> for weight management in people with a body mass index (BMI) of more than 30, or a BMI of more than 27 with another weight-related condition, like high blood pressure, Type 2 diabetes, or high cholesterol. Even if your plan covers Contrave, if you don\u2019t meet that criterion, you might not get coverage.\u00a0<\/span><\/p>\n

Prior Authorization<\/span><\/h3>\n

Some Aetna formularies note that they require <\/span>prior authorization<\/span><\/a> for certain drugs, including Contrave. This is typically how they determine that a non-preferred brand is, in fact, more medically necessary than a generic or preferred brand. \u201cInsurance plans that cover Contrave usually require a prior authorization form to be completed by the prescribing physician,\u201d Dr. Brown says. \u201cSome insurance plans require the patient to try losing weight through a physician-supervised weight loss program before they will cover Contrave.\u201d<\/span><\/p>\n

The Aetna plans that list Contrave as a non-preferred brand also typically require prior authorization. The requirements can vary based on the plan, but they\u2019ll typically require additional documentation from a qualified healthcare provider.<\/span><\/p>\n

Medicare and Medicaid<\/span><\/h3>\n

If you have an Aetna Medicare Part D or Medicare Advantage plan, Contrave isn’t typically covered. That\u2019s because Medicare plans are restricted by federal law from covering weight-loss drugs in general. Medicaid coverage varies by state, but most state Medicaid programs (including those administered by Aetna Better Health) also exclude weight-loss drugs like Contrave. If you’re not sure about our specific plan, contact your insurance company directly for more information.<\/span><\/p>\n

How to get approved for Contrave<\/span><\/h2>\n

The first step is to check the Aetna plan\u2019s formulary to see if it includes Contrave. If so, you could potentially receive coverage, depending on your medical profile and any prior authorization requirements. Then, schedule an appointment with your healthcare provider. After a physical exam, they can tell you whether they think Contrave would be a good fit for you and write you a prescription.<\/span><\/p>\n

Here\u2019s where it could get complicated. If your health insurance company requires prior authorization, you and your medical provider will need to take some other steps before you can receive coverage. Sometimes, it\u2019s as simple as the provider sending documentation of your symptoms, adverse reactions to other weight loss medications, or your progress on a diet and exercise plan. Other times, you might need to try a different drug first, and if that fails, you can move on to Contrave, a process called <\/span>step therapy<\/span><\/a>.\u00a0<\/span><\/p>\n

And you haven\u2019t already been on a diet and exercise plan, some plans might require you to try that for a certain number of months before they\u2019ll approve a weight loss drug. Regardless of the requirements, your healthcare provider is your ally in the process and can help you navigate it and achieve your weight-loss goals.\u00a0<\/span><\/p>\n

How much does Contrave cost?<\/span><\/h2>\n

For people paying completely out of pocket, or whose <\/span>insurance plan won\u2019t cover Contrave<\/span><\/a>, the drug can cost around $839 for 120, 8\u201390 mg tablets. That\u2019s a 30-day supply, so those costs can add up to over $10,000 annually. Contrave\u2019s website<\/span> says that if you have insurance coverage, your copay could be as low as $20 per month. But again, this depends on the plan. If your insurance policy classifies Contrave as a non-preferred drug, you might have to pay more.<\/span><\/p>\n

There’s currently no FDA-approved generic version of Contrave available in the U.S., so brand-name Contrave is the only option.<\/span><\/p>\n

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\n\t\t\t\t\tContrave 8 mg naltrexone, 90 mg bupropion (120 Tablets)\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t$613.45\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
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\n\t\t\t\t\t$613.45\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\tSee Contrave prices at all pharmacies<\/a>\n\t\t<\/div>\n\n\t\t<\/span><\/p>\n

How to check whether your Aetna plan covers Contrave\u00a0<\/span><\/h2>\n

\u201cThe best way for patients to determine if Contrave is covered by their insurance plan is to either check their insurance drug formulary or have their healthcare provider send a prescription for Contrave to the pharmacy for a coverage check,\u201d Dr. Brown says.<\/span><\/p>\n

Your formulary will tell you whether your plan considers Contrave a preferred brand, a non-preferred brand, or a non-formulary drug. Fortunately, <\/span>Aetna has a page<\/span><\/a> where you can access the formulary for any of its plans. On this page, select the applicable year and plan from the dropdown boxes, and it\u2019ll provide a link to your plan details.\u00a0<\/span><\/p>\n

Then, you can either click the \u201cFind Medicine\u201d button to search for Contrave by name, or you can click a link to a PDF of the plan\u2019s formulary and scroll down to find Contrave. Either way, the formulary should also tell you whether the plan has any prior authorization requirements or quantity limits.\u00a0<\/span><\/p>\n

If you have an account on the Aetna website, you can also log in to find details about your plan. Or, if you\u2019d rather speak with a person, you can call the number on your ID card to reach member support.\u00a0<\/span><\/p>\n

What to do if insurance won’t cover Contrave<\/span><\/h2>\n

Aetna may deny coverage, but you still have options before you start paying the full retail price out of pocket.<\/span><\/p>\n