{"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":"2025-06-10T13:36:03","modified_gmt":"2025-06-10T17:36:03","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":"

Weight loss is a huge industry in the United States. Americans spend an estimated $33 billion every year in pursuit of shedding pounds, according to the National Institutes of Health. And a sizable chunk of that spending is on weight loss drugs. Contrave <\/span>(naltrexone\/bupropion)<\/span> is a popular choice, and by increasing dopamine in the brain, it can help reduce appetite and body weight. But its prices can look intimidating, leaving some looking to insurance for help.\u00a0<\/span><\/p>\n

Some Aetna healthcare plans may cover Contrave, but it depends on several factors. We\u2019ve got all the important details below.\u00a0<\/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 <\/span>a 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 most likely to cover generic drugs and preferred drugs, and it won\u2019t cover non-formulary drugs at all.\u00a0<\/span><\/p>\n

Aetna\u2019s many formulary 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 additional steps, or the coverage might not be as comprehensive as it would be for a 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 criteria, you might not receive coverage.\u00a0<\/span><\/p>\n

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

Some Aetna formularies will 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 state they require prior authorization. The requirements can vary based on the plan, but they\u2019ll typically require additional documentation from a qualified healthcare provider.\u00a0\u00a0<\/span><\/p>\n

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

The first step is checking whether 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 <\/span>prior authorization<\/span><\/a>, 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\u2014a 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 they 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 $842 for 120, 8\u201390 mg tablets. That\u2019s a 30-day supply, so those costs can add up to over $10,000 annually. <\/span>Contrave\u2019s website<\/span><\/a> 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\t\t

\n\t\t\t

Save up to 80% on Contrave with SingleCare<\/p>\n\t\t\t

Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.<\/p>\n\t\t\t

\n\t\t\t\t
\n\t\t\t\t\tContrave 8 mg naltrexone, 90 mg bupropion (120 Tablets)\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t23666 - Hampton, VA\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t
\n\t\t\t\"Kroger\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\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
\n\t\t\t
\n\t\t\t\"Harris\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\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\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 their 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 and find details about your plan there. Or, if you\u2019d rather speak with a person, you can call the number listed on your ID card to get in touch with member support.\u00a0<\/span><\/p>\n

How to save on Contrave<\/span><\/h2>\n

The prices for Contrave might look intimidating if you\u2019re paying entirely out of pocket, but <\/span>there are still ways to save<\/span><\/a>\u2014even if your plan doesn\u2019t offer coverage. For example, you can get free coupons from Singlecare, which can drop the cost from $842 to as low as $613. Signing up is free, and over 35,000 partner pharmacies nationwide accept the coupons. Just present your SingleCare card at a participating local pharmacy and you\u2019ll reap the discount.\u00a0<\/span><\/p>\n

Contrave\u2019s manufacturer offers a savings card and a patient assistance program (the CurAccess program) that can help decrease costs for both insurance-covered patients and non-covered patients. Medical providers are also good resources since they often know about other financial assistance sources.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Weight loss is a huge industry in the United States. Americans spend an estimated $33 billion every year in pursuit of shedding pounds, according to the National Institutes of Health. And a sizable chunk of that spending is on weight loss drugs. Contrave (naltrexone\/bupropion) is a popular choice, and by increasing dopamine in the brain, […]<\/p>\n","protected":false},"author":15,"featured_media":632521,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[15103,608,9825],"coauthors":[8861],"class_list":["post-632519","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-drug-pricing","tag-health-insurance","tag-weight-loss","wpautop"],"acf":[],"yoast_head":"\nHow to get Aetna to cover Contrave for weight loss<\/title>\n<meta name=\"description\" content=\"Some Aetna plans cover Contrave, but approval depends on your plan, medical condition, and prior authorization. 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