Skip to content
myglp1coverage.com

Aetna · Liver Disease (MASH)

Aetna coverage for Wegovy (Liver Disease (MASH))

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Prescribed by or in consultation with a specialist
  • Confirmed MASH diagnosis by FibroScan_VCTE, MRE, and liver_biopsy, fibrosis stage F2 to F3

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
  • To renew, the plan looks for 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.html

ACA Marketplace

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Prescribed by or in consultation with a specialist
  • Confirmed MASH diagnosis by FibroScan_VCTE, MRE, and liver_biopsy, fibrosis stage F2 to F3

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
  • To renew, the plan looks for 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.html

All Wegovy policies under Aetna · Check your card