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Aetna

Does Aetna cover Zepbound?

Yes. Aetna covers Zepbound 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: Zepbound 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

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

  • 2.5 mg/0.5 mL, 5 mg/0.5 mL, 7.5 mg/0.5 mL, 10 mg/0.5 mL, 12.5 mg/0.5 mL, 15 mg/0.5 mL — 2 mL (4 pre-filled single-dose pens) / 21 days; 6 mL (12 pre-filled single-dose pens) / 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.
  • Renewal: At least 12 weeks on therapy before the first renewal.

Not covered when

  • Zepbound vials and Zepbound Kwikpens are covered under the LillyDirect manufacturer program and not under this policy

Policy note: Policy groups Zepbound and Mounjaro as 'tirzepatide (Zepbound/Mounjaro)' for both OSA and weight loss criteria. The quantity limits table lists 'tirzepatide (Zepbound/Mounjaro) pre-filled single-dose pens' for all strengths from 2.5 mg to 15 mg. Zepbound vials and Kwikpens are excluded from this policy and covered under LillyDirect program.

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

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Full requirements: Zepbound for Obstructive Sleep Apnea (OSA) (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Moderate to severe OSA with obesity - initial approval

All of:

  • Request is for tirzepatide (Zepbound/Mounjaro)
  • Established diagnosis of moderate to severe OSA with AHI ≥ 15 events/hour on PSG or HSAT with technically adequate device
  • Current BMI ≥ 30 kg/m2
  • Used with reduced-calorie diet AND increased physical activity

Documentation to bring

  • Documentation of moderate to severe OSA diagnosis with AHI ≥ 15 events/hour on PSG or HSAT with technically adequate device
  • Current BMI documentation (≥ 30 kg/m2)

Quantity limits

  • 2.5 mg/0.5 mL, 5 mg/0.5 mL, 7.5 mg/0.5 mL, 10 mg/0.5 mL, 12.5 mg/0.5 mL, 15 mg/0.5 mL — 2 mL (4 pre-filled single-dose pens) / 21 days; 6 mL (12 pre-filled single-dose pens) / 63 days (84-day)

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: Positive response to treatment from baseline evidenced by a decrease in OSA symptoms. Patient must be treated with maintenance dosage based on individual treatment response and tolerability. AHI documentation is re-required at continuation.

Not covered when

  • Zepbound vials and Zepbound Kwikpens are covered under the LillyDirect manufacturer program and not under this policy
  • No PAP/CPAP trial required prior to approval

Policy note: Policy uses 'current BMI ≥ 30' (not baseline) for OSA indication. No PAP/CPAP prior therapy requirement stated. OSA must be moderate to severe (AHI ≥ 15 events/hour). Policy refers to tirzepatide as 'Zepbound/Mounjaro' jointly for OSA criteria, though Mounjaro is not FDA-approved for OSA — Mounjaro is FDA-approved only for T2DM. The OSA criteria section header says 'Tirzepatide (Zepbound/Mounjaro) ONLY' suggesting Mounjaro could be approved for this off-label use under this policy.

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

Open on its own page →

Questions people ask
Does Aetna cover Zepbound?
Yes. Aetna covers Zepbound 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 Zepbound approval last with Aetna?
Weight Loss — Applies to Employer and ACA Marketplace plans. Initial approval: 8 months. Renewal: every 12 months. Obstructive Sleep Apnea (OSA) — Applies to Employer and ACA Marketplace plans. Initial approval: 6 months. Renewal: every 12 months.
What does Aetna require to renew Zepbound?
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. At least 12 weeks on therapy before the first renewal. Obstructive Sleep Apnea (OSA) — Applies to Employer and ACA Marketplace plans. Positive response to treatment from baseline evidenced by a decrease in OSA symptoms. Patient must be treated with maintenance dosage based on individual treatment response and tolerability. AHI documentation is re-required at continuation.
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, Wegovy

Zepbound 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.