Coverage at a glance
| Indication | Coverage |
|---|---|
| Obesity / chronic weight management (Wegovy, all standard commercial plans) | Covered with PA |
| Cardiovascular risk reduction (Wegovy, SELECT indication) | Covered with PA |
| Obesity / weight management (Zepbound, FE-Compatible plans only) | Covered with PA |
| Obesity / weight management (Zepbound, standard commercial plans) | Not covered |
Plan type: Commercial non-Medicare (fully insured and self-funded employer plans). Each indication below lists the BMI and clinical thresholds, the prior-authorization documentation, and the published policy it comes from.
This varies by plan. Whether your specific plan covers either drug depends on two things: the plan type (FE-Compatible vs. standard commercial) and whether your employer elected the weight-management drug benefit if you are in a self-funded plan. Two people with the same Aetna card at different employers may have different coverage. Check your summary of benefits or call the number on your card before starting therapy.
Coverage by indication
| BMI threshold | BMI 30 or higher, or BMI 27 or higher with at least one weight-related comorbidity (type 2 diabetes, hypertension, dyslipidemia, or obstructive sleep apnea) |
| Step therapy | Six months in a comprehensive weight-management program (behavioral modification, reduced-calorie diet, increased physical activity) before approval |
| Continuation | At least 5 percent loss of baseline body weight within the first 3 months of therapy at stable maintenance dosing |
| Authorization length | 7 months initial, 12 months continuation |
What the prior authorization needs:
- Documented BMI within the accepted threshold
- Six months of comprehensive weight-management program participation with program name and dates
- Comorbidity documentation if BMI is 27 to 29.9
- Prescriber attestation that lifestyle modification alone proved inadequate
Policy 4774-C UDR 08-2023 v2. Source: Aetna Non-Medicare Prescription Drug Plan, Wegovy PA with Limit 4774-C UDR 08-2023 v2. Official payer PA policy page (HTML, fetched directly). Verified June 12, 2026.
| BMI threshold | BMI 27 or higher |
| Cardiovascular criteria | Documented established cardiovascular disease: prior heart attack, prior stroke, symptomatic peripheral arterial disease, or prior revascularization (CABG, PCI, or angioplasty). Patient must not have type 2 diabetes, which is the Ozempic pathway. |
| Step therapy | None specified for the cardiovascular indication. Patient must be on appropriate cardiovascular guideline-directed medications or have a clinical reason for non-use. |
| Authorization length | 7 months initial, 12 months continuation |
What the prior authorization needs:
- Established cardiovascular disease documented with prior heart attack, stroke, peripheral arterial disease, or revascularization
- BMI 27 or higher
- No active type 2 diabetes diagnosis
Policy 6410-C UDR 03-2024. Source: Aetna Non-Medicare Prescription Drug Plan, Wegovy (Cardiovascular) PA with Limit 6410-C UDR 03-2024. Official payer PA policy page (HTML, fetched directly). Verified June 12, 2026.
| BMI threshold | BMI 30 or higher, or BMI 27 or higher with at least one weight-related comorbidity (type 2 diabetes, hypertension, dyslipidemia, OSA, or cardiovascular disease) |
| Step therapy | No step therapy through other agents is specified in policy 6947-C for FE-Compatible plans. The six-month lifestyle program documentation is required. |
| Continuation | At least 5 percent loss of baseline body weight within the first 3 months of therapy |
| Authorization length | 8 months initial, 12 months continuation |
What the prior authorization needs:
- FE-Compatible plan type required. This policy does not apply to standard commercial plan series (ACCF, ACF, ACFC, SCCF, SF, SFC, VF, VFC).
- Documented BMI within the accepted threshold
- Six months of structured weight-management program participation
- Comorbidity documentation if BMI is 27 to 29.9
Policy 6947-C P04-2025. Source: Aetna Non-Medicare Prescription Drug Plan, Zepbound PA with Limit FE Compatible 6947-C P04-2025 (effective July 1, 2025). Official payer PA policy page (HTML, fetched directly). Verified June 18, 2026.
On standard commercial plan series (ACCF, ACF, ACFC, SCCF, SF, SFC, VF, VFC), Zepbound is non-formulary for weight loss since July 1, 2025, when CVS Caremark removed it from Standard, Advanced Control, and Value formularies. A formulary exception under policy 6981-A requires documented step-through of Wegovy (semaglutide 2.4 mg) first. If Wegovy is contraindicated or not tolerated, an exception may be granted without step-through. Self-funded employer plans were not bound by this CVS Caremark decision and may retain Zepbound coverage.
| Effective date | 2025-07-01 |
Policy 6981-A P04-2025. Source: Aetna Non-Medicare Prescription Drug Plan, Zepbound Exception Policy 6981-A P04-2025 (effective July 1, 2025). Official payer PA policy page (HTML, fetched directly). Verified June 18, 2026.
Recent change: Effective July 1, 2025, CVS Caremark (Aetna's pharmacy benefit manager) removed Zepbound from standard commercial formularies for weight loss. Wegovy remains the preferred covered GLP-1 on standard formularies. Zepbound retains prior-authorization coverage on FE-Compatible plan types under policy 6947-C P04-2025. Self-funded employer plans were not bound by this CVS Caremark decision and may still cover Zepbound.
What to do next
If you qualify under one of the covered indications above, prior authorization is the path. Match the documentation in the requirements list then have your prescriber submit it.
- Start with the Aetna prior-authorization letter template, which cites this plan's policy and the diagnosis codes a reviewer looks for. Pick the indication that matches your clinical picture.
- Read the full coverage picture, denial reasons, and the four appeal pathways at GLP-1 insurance coverage.
- Call the number on your insurance card and ask whether your specific plan includes the weight-management drug benefit before you submit.
- If your plan does not cover the indication you need, compare cash-pay options in the cost guide and the cheapest legitimate programs.
Frequently asked questions
Does Aetna cover Wegovy for weight loss?
Yes. Aetna covers Wegovy (semaglutide 2.4 mg) for chronic weight management with prior authorization on its standard commercial formulary under policy 4774-C UDR 08-2023 v2. Requirements: BMI 30 or higher, or BMI 27 or higher with at least one weight-related comorbidity (type 2 diabetes, hypertension, dyslipidemia, or obstructive sleep apnea), plus six months in a comprehensive weight-management program. Continuation requires at least 5 percent body weight loss within the first three months at stable maintenance dosing. Self-funded employer plans can carve out the weight-management benefit, so confirm with your plan before you start. Policy verified June 12, 2026.
Does Aetna cover Zepbound?
It depends on your plan type. Aetna covers Zepbound with prior authorization on FE-Compatible commercial plans under policy 6947-C P04-2025, with the same BMI criteria as Wegovy (BMI 30 or higher, or BMI 27 or higher with a comorbidity) and a six-month lifestyle program requirement. On standard commercial plan series (ACCF, ACF, ACFC, SCCF, SF, SFC, VF, VFC), Zepbound was removed from formulary for weight loss effective July 1, 2025, and requires a formulary exception with a documented Wegovy step-through under policy 6981-A. Self-funded employers can retain Zepbound coverage regardless of the CVS Caremark standard formulary decision. Policy verified June 18, 2026.
What BMI does Aetna require for GLP-1 coverage?
Aetna's published prior-authorization policies for both Wegovy and Zepbound require BMI 30 or higher for obesity without a comorbidity, or BMI 27 or higher with at least one documented weight-related comorbidity: type 2 diabetes, hypertension, dyslipidemia, or obstructive sleep apnea. The same threshold applies across both the obesity indication and the FE-Compatible Zepbound policy. Additionally, Aetna separately covers Wegovy for cardiovascular risk reduction with a BMI threshold of 27 or higher plus established cardiovascular disease, which is a distinct pathway from pure obesity coverage.
Why might Aetna deny Wegovy or Zepbound even if I meet the BMI criteria?
Three common denial reasons: (1) Your employer's self-funded plan excluded the weight-management drug benefit, even though Aetna's standard formulary would cover it. (2) You are on a standard commercial plan series and are requesting Zepbound, which was removed from standard formularies for weight loss effective July 1, 2025 and requires a Wegovy step-through exception. (3) The prior-authorization documentation was incomplete, typically the six-month lifestyle program was not adequately documented. The strongest PA submissions include the program name, dates of participation, and a prescriber attestation that lifestyle intervention alone proved inadequate.
Coverage for other payers
See the full payer coverage index for every plan we have sourced.
How we built this page
Each page is built from a published payer policy document, government statute, or independent formulary analysis (KFF). Every indication row carries the source URL and the date we verified it. Where a payer's policy PDF was confirmed at its public URL but served as an unreadable binary, the policy number and coverage framework were cross-checked against secondary sources; those rows are marked lower confidence. Commercial coverage often depends on whether an employer elected the weight-management benefit. Those rows say varies by plan rather than a flat yes.
This is reference information, not medical or legal advice, and not a guarantee of coverage. GLP-1 coverage policies change often. Always confirm the current policy with your insurer using the number on your card before you rely on this page. If your experience differs from what is shown here, email hello@glpchart.com with the details and we will re-verify.
