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Aetna

Does Aetna cover Wegovy?

Yes. Aetna covers Wegovy for weight loss with prior authorization if your BMI is 35 or higher. Other policy requirements and your plan's benefits also apply.

Policy on file; the document isn't available to view online yet.

  • Employer and ACA Marketplace: Covered with requirements. See the qualification pathways below.

Earliest policy review June 2, 2026. How we verify · Check your exact plan

Full requirements: Wegovy for Weight Loss (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Adult weight loss - initial approval

All of:

  • Age 18 years or older
  • Baseline BMI ≥ 35 kg/m2
  • Participated in comprehensive weight management program (behavioral modification, reduced-calorie diet, increased physical activity) with continuing follow-up for at least 6 months prior to drug therapy
  • Used with reduced-calorie diet AND increased physical activity
  • Request is NOT for Wegovy HD 7.2 mg injection OR Wegovy tablets (injection only for adult weight loss criteria)

Documentation to bring

  • Baseline BMI documentation (≥ 35 kg/m2)
  • Documentation of participation in a comprehensive weight management program for at least 6 months prior to drug therapy

Quantity limits

  • 0.25 mg/0.5 mL, 0.5 mg/0.5 mL, 1 mg/0.5 mL — 2 mL (1 package of 4 pens) / 21 days; 6 mL (3 packages of 4 pens each) / 63 days (84-day)
  • 1.7 mg/0.75 mL, 2.4 mg/0.75 mL — 3 mL (1 package of 4 pens) / 21 days; 9 mL (3 packages of 4 pens each) / 63 days (84-day)

Approval and renewal

  • Initial approval: 8 months
  • Renewal: every 12 months
  • Renewal: Patient must have completed at least 3 months of therapy at a stable maintenance dose AND lost at least 5% of baseline body weight OR maintained initial 5% weight loss. Baseline BMI ≥ 35 is re-verified at continuation.
  • Renewal: At least 12 weeks on therapy before the first renewal.

Not covered when

  • Wegovy HD 7.2 mg injection is excluded from adult weight loss criteria under this policy section (has its own separate criteria)
  • Wegovy tablets are excluded from this specific adult weight loss injection criteria section (tablets have separate DOA)

Policy note: This policy is specifically titled 'BMI 35' and requires a baseline BMI ≥ 35 kg/m2 for adult weight loss (higher than the FDA label threshold of ≥ 27 with comorbidity or ≥ 30). Wegovy HD 7.2 mg injection has a separate DOA entry (Initial: 8 months, Continuation: 12 months) but its criteria are not separately detailed — it appears to follow the same adult weight loss criteria. Wegovy tablets have an Initial DOA of 6 months and Continuation DOA of 12 months. Concomitant use with other semaglutide-containing products or other GLP-1 receptor agonists is not recommended.

Policy effective April 10, 2026 · verified June 2, 2026 · source: Policy 260

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Full requirements: Wegovy for Heart Disease Risk Reduction (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

CV risk reduction - initial approval (Wegovy injection only, not HD)

All of:

  • Request is for Wegovy (semaglutide) injection — NOT Wegovy HD 7.2 mg injection
  • Used with reduced-calorie diet AND increased physical activity
  • Patient does NOT have type 2 diabetes
  • Baseline BMI ≥ 27 kg/m2
  • Currently receiving GDMT for CVD OR has clinical reason not to receive GDMT

Plus any one of:

  • Previous MI
  • Previous stroke
  • Symptomatic PAD with ABI < 0.85 at rest, peripheral arterial revascularization, or amputation due to atherosclerotic disease
  • Prior history of revascularization (CABG, PCI, or angioplasty)

Documentation to bring

  • Documentation of qualifying CVD event (MI, stroke, PAD with ABI < 0.85/revascularization/amputation, or prior CABG/PCI/angioplasty)
  • Baseline BMI documentation (≥ 27 kg/m2)
  • Documentation of current GDMT use (lipid-lowering agent, antiplatelet, beta-blocker, renin-angiotensin inhibitor) OR clinical reason GDMT is not appropriate
  • Documentation confirming patient does NOT have type 2 diabetes

Quantity limits

  • 0.25 mg/0.5 mL, 0.5 mg/0.5 mL, 1 mg/0.5 mL — 2 mL (1 package of 4 pens) / 21 days; 6 mL (3 packages of 4 pens each) / 63 days (84-day)
  • 1.7 mg/0.75 mL, 2.4 mg/0.75 mL — 3 mL (1 package of 4 pens) / 21 days; 9 mL (3 packages of 4 pens each) / 63 days (84-day)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Continuation requires: established CVD history (one of MI, stroke, PAD, revascularization) re-verified; patient being treated with maintenance dosage based on individual treatment response and tolerability. T2DM exclusion and GDMT requirement are NOT re-verified at continuation per the continuation criteria section.

Not covered when

  • Type 2 diabetes patients are excluded (directed to Ozempic instead)
  • Wegovy HD 7.2 mg injection is excluded from CV risk reduction coverage
  • Wegovy tablets have a separate CV risk reduction DOA of 12 months but criteria are not separately detailed in the document

Policy note: Policy explicitly states patients with T2DM may be treated for CV risk reduction with Ozempic instead. Wegovy tablets are also approved for CV risk reduction per FDA and listed in DOA section (12 months) but the detailed criteria section specifies 'Wegovy ONLY (EXCLUDING Wegovy HD 7.2 mg Injection)' without separately calling out tablets — tablets appear to fall under same CV criteria. GDMT examples listed: lipid-lowering agent, antiplatelet, beta-blocker, renin-angiotensin inhibitor.

Policy effective April 10, 2026 · verified June 2, 2026 · source: Policy 260

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Full requirements: Wegovy for Liver Disease (MASH) (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Noncirrhotic MASH with moderate to advanced fibrosis (F2-F3) - initial approval

All of:

  • Request is for Wegovy (semaglutide) injection — NOT Wegovy HD 7.2 mg injection OR Wegovy tablets
  • Used with reduced-calorie diet AND increased physical activity
  • Prescribed by or in consultation with a gastroenterologist or hepatologist
  • Noncirrhotic MASH diagnosis
  • Moderate to advanced liver fibrosis (stages F2 to F3) confirmed by non-invasive liver disease assessment (e.g., ultrasound-based elastography, MRE) OR historical liver biopsy

Documentation to bring

  • Documentation of noncirrhotic MASH diagnosis with moderate to advanced liver fibrosis (F2-F3)
  • Non-invasive liver disease assessment results (e.g., ultrasound-based elastography, MRE) OR historical liver biopsy confirming F2-F3 fibrosis
  • Documentation of prescribing or consulting gastroenterologist or hepatologist

Quantity limits

  • 0.25 mg/0.5 mL, 0.5 mg/0.5 mL, 1 mg/0.5 mL — 2 mL (1 package of 4 pens) / 21 days; 6 mL (3 packages of 4 pens each) / 63 days (84-day)
  • 1.7 mg/0.75 mL, 2.4 mg/0.75 mL — 3 mL (1 package of 4 pens) / 21 days; 9 mL (3 packages of 4 pens each) / 63 days (84-day)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Positive clinical response required: improvement in liver function such as reduction in ALT, improvement in Enhanced Liver Fibrosis (ELF) score, improvement in liver stiffness measurement (LSM) by ultrasound-based elastography or MRE. Patient must be treated with maintenance dosage based on individual treatment response and tolerability.

Not covered when

  • Wegovy HD 7.2 mg injection is excluded from MASH coverage
  • Wegovy tablets are excluded from MASH coverage
  • Cirrhotic MASH is excluded (noncirrhotic only)

Policy note: MASH indication approved under FDA accelerated approval. Policy specifies confirmation methods as non-invasive liver disease assessment (e.g., ultrasound-based elastography, MRE) OR historical liver biopsy — no specific lookback period stated. Specialist (gastroenterologist or hepatologist) required at initial approval. Continuation does not re-require specialist attestation per the continuation criteria text. DOA is 12 months for both initial and continuation.

Policy effective April 10, 2026 · verified June 2, 2026 · source: Policy 260

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Questions people ask
Does Aetna cover Wegovy?
Yes. Aetna covers Wegovy for weight loss with prior authorization if your BMI is 35 or higher. Other policy requirements and your plan's benefits also apply.
How long does a Wegovy approval last with Aetna?
Weight Loss — Applies to Employer and ACA Marketplace plans. Initial approval: 8 months. Renewal: every 12 months. Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months. Liver Disease (MASH) — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does Aetna require to renew Wegovy?
Weight Loss — Applies to Employer and ACA Marketplace plans. Patient must have completed at least 3 months of therapy at a stable maintenance dose AND lost at least 5% of baseline body weight OR maintained initial 5% weight loss. Baseline BMI ≥ 35 is re-verified at continuation. At least 12 weeks on therapy before the first renewal. Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. Continuation requires: established CVD history (one of MI, stroke, PAD, revascularization) re-verified; patient being treated with maintenance dosage based on individual treatment response and tolerability. T2DM exclusion and GDMT requirement are NOT re-verified at continuation per the continuation criteria section. Liver Disease (MASH) — Applies to Employer and ACA Marketplace plans. Positive clinical response required: improvement in liver function such as reduction in ALT, improvement in Enhanced Liver Fibrosis (ELF) score, improvement in liver stiffness measurement (LSM) by ultrasound-based elastography or MRE. Patient must be treated with maintenance dosage based on individual treatment response and tolerability.
How current is this information?
The oldest review date among the policies on this page is June 2, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Aetna: Mounjaro, Ozempic, Zepbound

Wegovy under other plans: Centene, Cigna, Medicare GLP-1 Bridge (CMS), UnitedHealthcare, Alabama Medicaid, BCBS Alabama, BCBS Arizona, BCBS Arkansas

All insurance plans · All medications

Summary of Aetna's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.