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Published: Jul 31, 2025

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Does Aetna cover Mounjaro for weight loss?

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Written by Alex Kilpatrick

Medically Reviewed by Klarity Editorial Team

Published: Jul 31, 2025

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Are you wondering, “Does Aetna cover Mounjaro for weight loss?” Aetna typically covers Mounjaro (tirzepatide) for type 2 diabetes, but Aetna isn’t likely to cover Mounjaro for weight loss. The active ingredient tirzepatide is also used in Zepbound, which is U.S. Food and Drug Administration (FDA)-approved for weight loss, so Aetna is more likely to cover Zepbound than Mounjaro for weight loss.

During this guide, you’ll learn about eligibility criteria for coverage, how to know if your Aetna covers Mounjaro for weight loss, tips for improving your chances for approval, and more. Find a licensed provider on Klarity Health and get a telehealth appointment with a licensed healthcare provider within 24 hours.

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Does Aetna cover Mounjaro for weight loss?

Mounjaro is an injectable prescription medication approved by the FDA to reduce blood sugar levels in people with type 2 diabetes. Type 2 diabetes is a chronic disease where your body doesn’t create enough insulin or can’t use the insulin it produces, which leads to increased blood sugar levels.

Mounjaro is part of a medication class called dual glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonists. GIP is a hormone that stimulates insulin release from your pancreas when you consume glucose. GLP-1 is another hormone that stimulates insulin release, reduces blood sugar levels by suppressing glucagon secretion, and promotes feelings of fullness. Dual GIP/GLP-1 receptor agonists, such as Mounjaro, combine the effects of GIP and GLP-1 receptor activation to better control blood sugar levels in people with type 2 diabetes.

Mounjaro works for weight loss by mimicking the effects of GIP and GLP-1, which regulate blood sugar and appetite. The medication slows down the emptying of your stomach, which makes you feel full longer and helps your body process sugar better, often leading to decreased food intake and weight loss. Mounjaro isn’t FDA-approved for weight loss, but it’s sometimes prescribed off-label for weight loss when combined with lifestyle changes. 

Wondering if Aetna covers Mounjaro for weight loss? Aetna doesn’t typically cover Mounjaro for weight loss, since it’s not FDA-approved for weight loss. Instead, Aetna will often cover Zepbound, which has the same active ingredient and is FDA-approved for weight loss.

Eligibility criteria for Aetna coverage for Mounjaro for weight loss

Aetna usually requires prior authorization for Mounjaro for weight loss. Aetna coverage for Mounjaro for weight loss usually depends on meeting specific eligibility criteria related to body mass index (BMI), previous weight loss attempts, and previous participation in a comprehensive weight management program. 

Here are the eligibility criteria for Aetna coverage for Mounjaro for weight loss. You usually need to meet all of these criteria for coverage:

  • Age. You need to be at least 18 years old or older to receive Aetna coverage for Mounjaro for weight loss.
  • BMI. You usually need a baseline BMI of at least 35 kilograms per meters squared (kg/m2). Some Aetna plans might cover Mounjaro for weight loss if you have a BMI of at least 30 kg/m2, as long as you also have at least 1 weight-related comorbidity, such as type 2 diabetes or hypertension. If you do have type 2 diabetes, it’s much easier to get Aetna coverage for Mounjaro for diabetes than for weight loss.
  • Weight management program. You usually must have participated in a comprehensive weight management program for at least 6 months. This program must include increased physical activity, a reduced-calorie diet, and behavioral modification.
  • Prior authorization. Most Aetna plans require that you receive prior authorization for Mounjaro for weight loss. This means your licensed healthcare provider needs to submit documents that show you meet the eligibility criteria for Aetna coverage.

If you don’t meet these eligibility criteria, Aetna will typically cover other weight loss medications, such as Zepbound or Wegovy, as long as you meet specific criteria and receive prior authorization for those medications.

How to know whether my Aetna covers Mounjaro for weight loss

Here are a couple of the best ways to figure out whether your Aetna plan covers Mounjaro for weight loss:

  • Check the Aetna website or mobile app.
    • First, log in to your Aetna member account either through the secure website or mobile app.
    • Navigate to the Find a Medication tool, then search for Mounjaro or tirzepatide.
    • Review the coverage details for Mounjaro, including any restrictions or prior authorization requirements.
    • Check the website for potential cost information for Mounjaro for weight loss, including coinsurance or copays.
    • Check for information about retail pharmacy or mail-order options.
  • Contact Aetna directly.
    • Find the Aetna customer service phone number on the website or on your member ID card.
    • Have your Aetna plan information and your member ID readily available to answer any questions about your coverage.
    • Explain to the customer service representative that you’re wondering about your Aetna coverage for Mounjaro for weight loss.
    • Ask the representative about specific details about coverage for Mounjaro for weight loss, including coinsurance, copays, restrictions, and prior authorization requests.
    • Ask whether Mounjaro for weight loss is covered by your specific Aetna plan.

Does Aetna cover an online Mounjaro prescription for weight loss?

Whether Aetna covers an online Mounjaro prescription for weight loss depends on your particular Aetna plan and whether Mounjaro is considered medically necessary for you. You need to check your plan’s medication list or formulary. You typically need to get prior authorization for an online Mounjaro prescription for weight loss.

Why Aetna might deny Mounjaro coverage for weight loss

Aetna might deny Mounjaro coverage for weight loss for a few reasons:

  • Not an FDA-approved indication. Mounjaro is only FDA-approved to treat type 2 diabetes in adults. If you want to use Mounjaro for an off-label use, like weight loss, Aetna will probably deny coverage for you. If you have type 1 diabetes, rather than type 2 diabetes, or if you have a history of pancreatitis, Aetna will likely deny coverage, since these conditions are not FDA-approved uses for Mounjaro.
  • No prior authorization. Aetna usually requires prior authorization for Mounjaro for weight loss, which means your prescribing provider needs to offer information about your diagnosis and treatment plan to Aetna for medication approval. If the prior authorization isn’t completed or the information doesn’t meet Aetna’s eligibility criteria, they can deny the claim.
  • Not a medical necessity. Aetna might deny coverage for Mounjaro for weight loss if they don’t consider it medically necessary for you, particularly if there are equally effective and less expensive medications available.
  • Not in the formulary. Check the formulary for your specific Aetna plan. If Mounjaro isn’t listed as a covered medication in your specific plan, Aetna is more likely to deny coverage.

Tips for improving your chances of Mounjaro approval for weight loss

Here are a few tips for improving your chances of Mounjaro approval:

  • Type 2 diabetes diagnosis. The most important thing you need to have in hand to improve your chances of Mounjaro approval is to have a confirmed diagnosis of type 2 diabetes from a licensed and board-certified healthcare provider. Mounjaro is FDA-approved to treat type 2 diabetes in adults.
  • Document your previous treatment history. Many health insurance plans require step therapy. Step therapy is a strategy where you try other less expensive medications first before Mounjaro. They want documentation that you’ve tried other medications first, which have either failed or resulted in harsh, intolerable side effects. Make sure your medical documents clearly state the medications you tried, doses, treatment duration, and reasons for inadequate response or discontinuation.
  • Emphasize the effectiveness of Mounjaro. Offer evidence of the effectiveness of Mounjaro, particularly if you’ve already started the medication. Your doctor’s medical records and lab results should also note your positive response to Mounjaro.

Alternatives and savings options if Aetna doesn’t cover Mounjaro for weight loss

If Aetna doesn’t cover Mounjaro for weight loss for you, you have several other options to consider:

  • Explore alternative medications to Mounjaro. There are several other medications to consider besides Mounjaro for weight loss, including Zepbound, other GLP-1 receptor agonists, and other weight loss medications.
    • Zepbound also contains tirzepatide, the same active ingredient as Mounjaro, but the medication is FDA-approved for chronic weight management.
    • Other GLP-1 receptor agonists, such as Ozempic (semaglutide), Wegovy (semaglutide), and Saxenda (liraglutide), are often prescribed for weight loss.
    • Other weight loss medications include phentermine, Qsymia (phentermine-topiramate), Contrave (naltrexone-bupropion), Xenical (orlistat), and Alli (orlistat). 
  • Savings programs and options. There are also many other savings options and programs if you can’t get coverage from Aetna.
    • Manufacturer savings cards. You might be eligible for manufacturer savings cards if you have commercial insurance. These cards can decrease your out-of-pocket costs for Mounjaro.
    • Prescription discount cards. Platforms like GoodRx and SingleCare provide free discount cards that can reduce the cost of Mounjaro at participating pharmacies.
    • Patient assistance programs (PAPs). Pharmaceutical manufacturers often offer these PAPs, which provide discounted or free medications to underinsured or uninsured people who meet the eligibility requirements.
    • Fill a 90-day supply. Getting a larger supply of Mounjaro can help lower the overall cost of the medication.
    • Community health centers offer affordable health care and typically have pharmacies that give you prescription medications either at lower costs or on a sliding scale based on your income.
  • Appeal to Aetna’s decision. Your licensed healthcare provider might be able to appeal Aetna’s decision to deny coverage by offering documentation that proves the medical necessity of Mounjaro for you. You can work with your provider to get documentation, including clinical notes and medical records, together to support your appeal.

How to get prior authorization from Aetna for Mounjaro for weight loss

Here’s what you need to do to get prior authorization from Aetna for Mounjaro for weight loss:

  • Check the prior authorization requirements. First, you need to confirm through Aetna’s drug search tool or your Aetna plan’s formulary if Mounjaro for weight loss requires prior authorization for your particular Aetna plan.
  • Get all the necessary documentation together. Work with your licensed healthcare provider to collect all of your medical records, including relevant lab results and diagnostic test results. You also need documentation of your age, BMI, any previous weight loss attempts, and that you’ve completed a 6-month comprehensive weight management program.
  • Have your provider submit the prior authorization request. Your licensed healthcare provider then needs to submit the prior authorization request either electronically or by phone. If your provider isn’t able to submit the request electronically, they can contact Aetna’s Precertification Department by using the phone number on your member ID card.
  • Wait for a decision. Aetna usually processes prior authorization requests within 14 days or 2 weeks. Aetna will either approve or deny the request, or they might request additional information.

Key takeaways

Here are some of the key takeaways:

  • Mounjaro works for weight loss by mimicking the effects of GIP and GLP-1, which regulate blood sugar and appetite. The medication slows down the emptying of your stomach, which makes you feel full longer and helps your body process sugar better, often leading to decreased food intake and weight loss.
  • Mounjaro isn’t FDA-approved for weight loss, but it’s sometimes prescribed off-label for weight loss when combined with lifestyle changes. 
  • Aetna doesn’t typically cover Mounjaro for weight loss, since it’s not FDA-approved for weight loss. Instead, Aetna will often cover Zepbound, which has the same active ingredient and is FDA-approved for weight loss.
  • Aetna usually requires prior authorization for Mounjaro for weight loss. Aetna coverage for Mounjaro for weight loss usually depends on meeting specific eligibility criteria related to body mass index (BMI), previous weight loss attempts, and previous participation in a comprehensive weight management program. 
  • Whether Aetna covers an online Mounjaro prescription for weight loss depends on your particular Aetna plan and whether Mounjaro is considered medically necessary for you.

Book an appointment on Klarity Health

Ready to get a prescription for Mounjaro for weight loss? With Klarity Health, getting a telehealth appointment with a licensed healthcare provider is fast, simple, and convenient. You can simply connect with a provider from your own home and receive quality medical care in as little as 24 hours. The Klarity Health platform connects you with board-certified healthcare providers who follow clinical guidelines.

Not sure if your insurance covers weight loss treatment?

Licensed providers on Klarity can assess your condition and help you explore care options—coverage may vary by plan.

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FAQs

*Appointments are generally available within 24 hours. Free initial consultations are available only with select providers. Prescriptions, particularly for controlled substances, may require an in-person evaluation depending on the state of residence and current federal regulations.

The information provided in this article is for educational purposes only and should not be construed as medical advice. Controlled substances may not be appropriate for all patients and any mention of these medications is for educational purposes only, not for marketing or encouraging self-diagnosis. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health. Providers on Klarity Health are independent practitioners with clinical autonomy. Nothing in this article is intended to diagnose or treat any condition, including guaranteeing prescription medication of any kind or dosage. Not all providers on Klarity Health prescribe all medications, particularly medications that are controlled substances.

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Check if your insurance covers weight loss care

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