Coverage at a glance
| Indication | Coverage |
|---|---|
| Obesity / chronic weight management | Covered with PA |
| Cardiovascular risk reduction (SELECT indication) | Covered with PA |
Plan type: Commercial non-Medicare. Each indication below lists the BMI and clinical thresholds, the prior-authorization documentation, and the published policy it comes from.
This varies by plan. Aetna covers Wegovy on its standard commercial formulary, but a self-funded employer can carve out anti-obesity drugs. Whether your specific plan includes the weight-management benefit depends on your employer's election. Check your summary of benefits or call the number on your card.
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 change, 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 |
| Authorization length | 12 months continuation |
What the prior authorization needs:
- Documented BMI within the accepted threshold
- Six months of comprehensive weight-management program participation
- Comorbidity documentation if BMI is 27 to 29.9
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). 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, angioplasty). The patient must not have type 2 diabetes, which is the Ozempic pathway. |
| Step therapy | None specified for the cardiovascular indication. The 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). Verified June 12, 2026.
Recent change: As of July 2025 Aetna removed Zepbound from many standard commercial formularies for weight loss. Wegovy remained covered with prior authorization.
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?
Yes. Aetna covers Wegovy with prior authorization on its standard commercial drug plan, for both the obesity indication and the cardiovascular indication. This reflects the published policy verified June 2026.
What does Aetna require to approve Wegovy?
For obesity / chronic weight management: The BMI requirement is 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). Six months in a comprehensive weight-management program (behavioral change, reduced-calorie diet, increased physical activity) before approval Authorization runs 12 months continuation.
Why might Aetna deny Wegovy even if I meet the criteria?
Aetna covers Wegovy on its standard commercial formulary, but a self-funded employer can carve out anti-obesity drugs. Whether your specific plan includes the weight-management benefit depends on your employer's election. Check your summary of benefits or call the number on your card.
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 and the row is marked lower confidence. Commercial coverage often depends on whether an employer elected the weight-management benefit, so 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.
