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.

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.

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 (Weight Loss)

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

Does Aetna cover Wegovy for Weight Loss?