Quick answer: does Aetna cover Wegovy? Only if your Aetna plan includes weight-loss drugs, and then only with prior authorization. Aetna’s standard criteria require a BMI of 30 or higher (or 27 or higher with a weight-related condition), at least 6 months in a weight management program, and 5% weight loss to renew.[2] Some 2026 Aetna plans use a stricter BMI of 35 or higher.[1] Wegovy is also covered under separate Aetna criteria for heart risk reduction and MASH liver disease.[1]
Prices and program terms checked October 2026. They change often; confirm with the manufacturer or your plan.
Wegovy contains semaglutide and is approved for weight management, for lowering heart attack and stroke risk in people with heart disease, and, as an injection, for MASH with moderate to advanced fibrosis.[8] For coverage beyond Aetna, see does insurance cover Wegovy.
Does your Aetna plan include weight-loss drugs?
This is the first question. Many employers choose not to cover drugs for weight loss. In KFF’s 2025 survey, 19% of large firms offering health benefits covered GLP-1s for weight loss, rising to 43% of firms with 5,000 or more workers.[10] If your plan excludes weight-loss drugs, no prior authorization will get Wegovy covered for that purpose.
Aetna’s criteria for weight management
Aetna publishes its pharmacy policies. There are two main versions you may run into.
Standard Wegovy criteria (adults 18+):[2]
- baseline BMI of 30 or higher, or 27 or higher with at least one weight-related condition such as high blood pressure, type 2 diabetes or high cholesterol
- at least 6 months in a comprehensive weight management program with behavior change, a reduced-calorie diet and more activity, before starting the drug
- documentation of the above
2026 “BMI 35” policy (covers Wegovy, Wegovy HD, the Wegovy pill, Zepbound, Mounjaro, Saxenda and Foundayo):[1]
- baseline BMI of 35 or higher at the start of drug therapy
- the same 6-month weight management program
- for children 12 to 17 on Wegovy injection, a BMI at or above the 95th percentile for age and sex
Which version applies depends on the plan your employer chose. Ask Aetna which weight-loss policy your plan follows.
Renewal and approval length
To continue Wegovy, you must have completed at least 3 months at a stable maintenance dose and lost at least 5% of your starting weight, or kept off that initial 5%.[1]
| Item | Aetna 2026 |
|---|---|
| Wegovy injection, adults, first approval | 8 months |
| Wegovy injection, ages 12 to 17, first approval | 7 months |
| Wegovy pill, first approval | 6 months |
| Renewal | 12 months |
| Wegovy injection 0.25 mg to 1 mg | 2 mL (one 4-pen box) per 21 days |
| Wegovy injection 1.7 mg, 2.4 mg and HD 7.2 mg | 3 mL per 21 days |
| Wegovy pill | 30 tablets per 25 days |
Source: Aetna policy 6450-C.[1]
The Wegovy pill and Wegovy HD
Aetna’s 2026 weight-loss policy lists the Wegovy pill and the higher-dose Wegovy HD 7.2 mg pen alongside the standard injection.[1] The pill gets a shorter first approval (6 months) and has its own quantity limit, so your prescriber should request the exact product and strength you plan to use. Wegovy HD is not included in Aetna’s heart-risk criteria, which cover only the standard injection and the pill.[1] If you change from the pen to the pill, or move up to HD, ask whether a new authorization is needed.
Heart risk reduction and MASH
Aetna covers Wegovy for other approved uses under separate criteria, approved for 12 months at a time:[1]
Heart risk reduction (Wegovy injection or pill, not Wegovy HD):
- established heart disease: a prior heart attack, stroke, symptomatic peripheral artery disease or revascularization
- BMI of 27 or higher
- no type 2 diabetes
- currently receiving standard heart treatment, or a medical reason not to
MASH (Wegovy injection only, not HD or tablets):
- moderate to advanced fibrosis (stage F2 to F3) confirmed by noninvasive testing or a past biopsy
- prescribed by or with a gastroenterologist or liver specialist
These uses can matter if your plan excludes weight-loss drugs, because they treat a separate disease. Ask Aetna whether your plan covers them.
The CVS Caremark formulary change
Aetna and CVS Caremark are both part of CVS Health. On July 1, 2025, CVS Caremark made Wegovy the preferred weight-loss GLP-1 on its main commercial template formularies and removed Zepbound. Members with an active Zepbound authorization did not need a new one to switch, and members could request an exception if Wegovy did not work or caused intolerable side effects.[4]
Aetna’s July 2026 exclusion list for its Standard Control Plan still lists Zepbound as not covered and names Wegovy among the covered alternatives.[3] In May 2026, CVS Caremark said Zepbound would return to its commercial formularies as a preferred option on October 1, 2026.[5] If you are weighing Zepbound, confirm your Aetna plan’s current list.
Aetna Medicare plans
- Weight loss: since July 1, 2026, eligible Aetna Medicare members can get Wegovy for $50 a month through the Medicare GLP-1 Bridge, which runs through December 31, 2027. CMS, not Aetna, approves these requests.[6][7]
- Heart risk reduction: a Wegovy prescription to lower cardiovascular risk goes to the Part D plan instead.[11]
See does Medicare cover Ozempic for the Bridge criteria.
How to check and apply
- Search your Aetna drug list for “Wegovy” in the member portal. Look for PA and quantity limits, or an exclusion.
- Call the number on your ID card. Ask whether weight-loss drugs are covered and which BMI policy applies.
- Gather records: a dated BMI, weight-related diagnoses and at least 6 months of lifestyle program notes.
- Have your prescriber submit PA. Our Wegovy prior authorization guide covers what to include and how to appeal.
Your cost with Aetna
With an Aetna commercial plan that covers Wegovy, Novo Nordisk’s savings offer can bring the cost to as little as $25, with up to $100 off a one-month fill. It cannot be used with Medicare, Medicaid or other government plans.[9] If you are not covered, compare cash prices in how to get semaglutide without insurance, or see does Aetna cover Ozempic if you have type 2 diabetes.
