Does Aetna Cover Wegovy? 2026 Prior Authorization Criteria, Medicare and Costs

Written by Diana Gangan. Updated October 30, 2026.

Aetna covers Wegovy for many members, but only if the plan includes weight-loss drugs and only after prior authorization. For most commercial plans the rules come from Aetna's published Wegovy policy: a BMI of 30 or more, or 27 or more with a weight-related condition, at least six months in a weight-management program before starting, and at least 5% weight loss to keep coverage after the first months. Whether your plan includes the benefit at all is usually your employer's decision, and many employers have said no. Aetna also covers Wegovy under a separate policy for people with heart disease, it has not sold ACA marketplace plans in 2026, and Aetna Medicare members can get Wegovy only through Medicare's GLP-1 Bridge, which is run by Medicare rather than by Aetna and costs $50 a month. This guide explains how to check your plan, what the prior authorization asks for, the 2025–2026 formulary changes at CVS Caremark, and what Wegovy costs if Aetna says no.

Most Aetna members get coverage through an employer, and in a self-funded plan the employer pays the claims and chooses the benefits; Aetna administers them. Weight-loss drugs are an optional benefit that many employers leave out because of cost. A 2025 KFF survey found that only 19% of firms with 200 or more workers covered GLP-1 drugs for weight loss, rising to 43% among firms with 5,000 or more workers. That is why two people with Aetna cards can get different answers: one employer bought the benefit, the other did not. The general rules that apply across insurers are in does insurance cover Wegovy.

Aetna publishes its prior authorization criteria. The standard weight-management policy for Wegovy (policy 4774-C) and a stricter version that applies in some states (5098-C) set out what your prescriber has to document. A separate policy (6410-C) covers the cardiovascular indication.

Under the standard policy, adolescents aged 12 to 17 qualify with a BMI at or above the 95th percentile for age and sex, plus the same six-month program. The first approval lasts seven months, which covers the 16-week dose escalation described in the Wegovy dosing schedule; renewals last 12 months. The state-specific policy does not list which states use it, so ask Aetna which applies to your plan.

The renewal test is weight loss. Under the standard policy, after at least three months at a stable maintenance dose you need to have lost at least 5% of your starting weight, or to have kept off an earlier 5% loss. Your prescriber documents your starting and current weight. If you could not tolerate 2.4 mg, the 1.7 mg maintenance dose counts as a stable maintenance dose under the current label, which can matter at renewal; this is explained in can you stay on a low dose of Wegovy. People who lose less than 5% may be refused, and stopping usually means regaining much of the weight, as covered in what happens when you stop taking Wegovy.

Yes, under a separate policy. Wegovy is approved to lower the risk of heart attack, stroke and cardiovascular death in adults with established heart disease and overweight or obesity, based on the SELECT trial. Aetna's cardiovascular policy requires a BMI of 27 or more, established cardiovascular disease (a previous heart attack or stroke, symptomatic peripheral artery disease, or a procedure to open an artery), no type 2 diabetes, and standard heart-disease treatment. People with type 2 diabetes are directed to Ozempic instead. Because this is a treatment for heart disease, some employer plans that exclude weight-loss drugs may still cover it, so it is worth asking your prescriber to submit under this policy if it applies to you. Wegovy also gained accelerated approval in August 2025 for MASH, a fatty liver disease with liver scarring; we could not find a published Aetna policy for that use, so ask Aetna directly.

Aetna and CVS Caremark are part of the same company, and Caremark manages prescription benefits for most Aetna commercial plans. On July 1, 2025, Caremark made Wegovy the preferred weight-loss drug on its largest standard formularies and dropped Zepbound from them. On October 1, 2026, Zepbound returned as an additional preferred option, so many plans now list both. Caremark has stressed that plan sponsors still have to choose to cover GLP-1 drugs at all. If you were moved from Zepbound to Wegovy in 2025, you may now be able to move back; how the two compare is in Zepbound vs Wegovy.

Medicare plans cannot cover drugs used only for weight loss, so Aetna Medicare Advantage and Part D plans do not cover Wegovy for that purpose. Since July 1, 2026, Medicare's GLP-1 Bridge has filled the gap. It covers the Wegovy injection or pill, Zepbound KwikPen and Foundayo for a $50 monthly copay until December 31, 2027. Aetna says plainly that the Bridge is not part of Aetna benefits: your doctor sends the request to Medicare, and Aetna does not approve it. Eligibility, according to Medicare.gov, requires a BMI of 35 or more; or 30 or more with heart failure with preserved ejection fraction, uncontrolled high blood pressure or stage 3a or worse kidney disease; or 27 or more with prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease. People with type 2 diabetes are excluded, because they have other covered options.

The Wegovy pill was approved in December 2025 and launched in January 2026. Plans that cover weight-loss drugs generally treat it under the same prior authorization rules as the injection, but formulary placement varies, so check whether your plan lists the pill specifically. NovoCare sells it for $149 a month at the 1.5 mg dose, $199 at 4 mg and $299 at 9 mg and 25 mg. The differences between the two forms are in Wegovy pill vs injection.

Novo Nordisk has announced that the list price of Wegovy, Ozempic and Rybelsus will fall to $675 a month on January 1, 2027, which may lower costs for people paying coinsurance or a deductible. Coupons and other ways to pay less are in Wegovy cost and savings.

If you have type 2 diabetes, Aetna will usually cover Ozempic, which is the same medicine as Wegovy, through a diabetes benefit with its own prior authorization. Aetna's Wegovy policies send people with type 2 diabetes to Ozempic. Prescribing Ozempic for weight loss without diabetes to get coverage is something insurers check for and refuse. The differences between the products are set out in Wegovy vs Ozempic, and what to expect on the scale is in how much weight you can lose on Wegovy.

Aetna covers Wegovy when your plan includes weight-loss drugs and you meet its prior authorization criteria: a BMI of 30 or more (27 with a weight-related condition), six months in a weight-management program, and at least 5% weight loss to renew. A separate policy covers people with heart disease. Aetna sold no marketplace plans in 2026, and Aetna Medicare members go through Medicare's $50 GLP-1 Bridge. If the answer is no, the self-pay price is $349 a month for the injection, and the list price drops to $675 in January 2027. If your coverage is through a Blue plan instead, see does Blue Cross Blue Shield cover Wegovy.

Coverage rules change at each plan year and differ between plans. This article summarizes published Aetna policies and reports for general information; confirm your own benefits with Aetna.