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Ozempic (semaglutide) has gained popularity for its proven effectiveness in aiding weight loss. However, insurance coverage for Ozempic, particularly with Aetna, can be complex. To understand if and how Aetna covers this medication, it’s important to be familiar with their policies, eligibility criteria, and the process for getting coverage. By knowing the key requirements, you can better navigate the approval process.
If you’re ready to move forward with your weight loss journey, book an appointment with a provider on Klarity Health today to explore your options and get the guidance you need.
Check if Ozempic is covered by your insurance
Talk to a provider through Klarity about your treatment options—Ozempic may be appropriate depending on your condition and coverage.
Does Aetna cover Ozempic for weight loss?
Yes, Aetna may cover Ozempic (semaglutide) for weight loss if certain criteria are met. Ozempic is approved by the U.S. Food and Drug Administration (FDA) for the management of type 2 diabetes, but its use for weight loss is considered off-label. Aetna may cover off-label use when specific medical necessity requirements are met.
Eligibility criteria for Aetna Ozempic coverage for weight loss
Typically, to qualify for Aetna’s coverage of Ozempic for weight loss, the following conditions must be met:
- Body mass index (BMI): A BMI of 30 or higher, or 27 or higher with at least one weight-related comorbidity, such as hypertension or type 2 diabetes.
- Previous weight loss attempts: Documentation of unsuccessful attempts at weight loss through lifestyle modifications, including diet and exercise.
- Medical supervision: Participation in a comprehensive weight management program under medical supervision.
- Prior authorization: Submission of a prior authorization request with supporting documentation from your healthcare provider.
It’s important to note that Aetna may have specific requirements depending on your plan, and these criteria can vary.
Why Aetna might deny Ozempic coverage for weight loss
Several factors can lead to Aetna denying coverage for Ozempic for weight loss:
- Off-label use: Although Ozempic is FDA-approved for the treatment of type 2 diabetes, it is not approved by the FDA for weight loss. Aetna generally does not cover off-label uses unless medically necessary and specific criteria are met.
- Lack of medical necessity: If your healthcare provider does not provide sufficient documentation to demonstrate that Ozempic is medically necessary for weight loss, Aetna may deny coverage.
- Non-compliance with criteria: Failure to meet Aetna’s specific eligibility criteria, such as BMI requirements or documentation of prior weight loss attempts, can result in denial.
- Plan exclusions: Some Aetna plans may specifically exclude coverage for weight loss medications.
How to check if your Aetna plan covers Ozempic for weight loss
To determine if your Aetna plan covers Ozempic for weight loss, follow these steps:
- Review your plan documents
Check your Summary of Benefits and Coverage (SBC) for detailed information about prescription drug coverage and exclusions. This document provides clarity on what is and isn’t covered under your plan. - Use Aetna’s drug search tool
Visit Aetna’s drug search tool to check if Ozempic is included in your plan’s formulary. The tool helps you identify specific medications and their coverage status. - Contact Aetna member services
Call the number on your Aetna member ID card to speak with a representative. They can provide detailed information about your coverage, including the requirements for approval. - Consult with your healthcare provider
Your healthcare provider can help determine whether Ozempic is medically appropriate for your weight loss journey and guide you through the prior authorization process if needed.
It’s important to verify this information with Aetna, as coverage criteria can vary depending on your plan and state regulations.
Alternatives and savings options if Aetna won’t cover Ozempic for weight loss
If Aetna doesn’t cover Ozempic for weight loss, alternative medications and savings options may be available. Including:
1. Wegovy (semaglutide)
Wegovy is a higher-dose formulation of semaglutide, approved by the FDA for chronic weight management. Aetna may cover Wegovy with prior authorization if the following criteria are met:
- Age: 18 years or older
- BMI:30 or greater, or 27 or greater with at least one weight-related comorbidity
- Previous Weight Loss Attempts: Documentation of unsuccessful weight loss attempts
- Medical Supervision: Participation in a structured weight management program under medical supervision
- Prior Authorization: A request must be submitted with supporting documentation
2. Saxenda (liraglutide)
Saxenda is another GLP-1 receptor agonist approved for weight management. Aetna may cover Saxenda with prior authorization under similar criteria to those for Wegovy.
3. Zepbound (tirzepatide)
Zepbound is a newer medication indicated for chronic weight management. As of July 1, 2025, Aetna no longer covers Zepbound for weight loss, but it may still be covered for adults with moderate to severe obstructive sleep apnea (OSA) and obesity. 4. Other weight loss medication alternatives:
- Orlistat (Xenical): A lipase inhibitor that reduces dietary fat absorption.
- Bupropion/naltrexone (Contrave): A combination medication that reduces appetite.
- Phentermine/topiramate (Qsymia): A combination of appetite suppressants.
Your healthcare provider can explore these alternatives with you to determine the most suitable treatment for your weight loss goals.
Savings options:
- Manufacturer Savings Programs: Check if the drug manufacturer offers patient assistance programs.
- Prescription Discount Cards: Programs like GoodRx can help you find lower prices at local pharmacies.
- Pharmacy Assistance Programs: Some pharmacies offer discount programs to help reduce the cost of medications.
How to get prior authorization from Aetna for Ozempic for weight loss
To request prior authorization for Ozempic, follow these steps:
- Consult your healthcare provider
Discuss the potential benefits of Ozempic for weight loss and whether it’s appropriate for you. - Gather necessary documentation
Collect medical records such as BMI measurements, previous weight loss attempts, and other relevant health information. - Submit the prior authorization request
Your healthcare provider will submit the prior authorization request to Aetna, including all necessary documentation through Aetna’s online portal or by contacting their pharmacy department. - Follow up
Monitor the status of your request. If necessary, provide additional documentation to Aetna to support your claim.
Next steps to get Ozempic for weight loss covered by Aetna online
If you’re considering Ozempic for weight loss and have Aetna insurance, it’s essential to understand the process. Aetna requires specific criteria to be met for coverage, which can be complex and challenging to understand. But with the right support, you can increase your chances of approval. At Klarity Health, we connect you with licensed, board-certified healthcare providers who offer personalized care both online and in-person—no insurance needed. Book an appointment with a provider today to discuss your options and explore weight loss services today.
Not sure if your insurance covers Ozempic?
Klarity connects you with providers who can assess your needs, offer medical guidance, and prescribe Ozempic if appropriate—coverage may vary by plan.
Frequently asked questions (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. 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.
