Does Aetna cover Wegovy?

Yes. Aetna covers Wegovy for liver disease (MASH) with prior authorization. Other policy requirements and your plan's benefits also apply.

How long does a Wegovy approval last with Aetna?

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?

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.

Aetna coverage for Wegovy (Liver Disease (MASH))

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

Does Aetna cover Wegovy for Liver Disease (MASH)?