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Obesity affects more than 40% of adults in the United States, making it a significant health issue. Prescription weight loss injections, such as Wegovy, Mounjaro, and Zepbound, offer a promising solution for many individuals. However, coverage for these treatments varies depending on your insurance provider and the specific plan you have. If you’re an Aetna member considering these treatments, it’s essential to understand your coverage options.
Ready to get started with a tailored weight-loss treatment plan? Book an appointment on Klarity Health today, and connect with a provider to guide you through the process of getting your weight loss treatment covered.
Check if your insurance covers weight loss care
Discuss your needs with a Klarity provider—treatment options and coverage vary by plan.
Does Aetna cover weight loss injections?
Yes, Aetna may cover certain weight loss injections, but only if you meet certain criteria and get prior authorization from your provider. Keep in mind that many Aetna plans exclude obesity treatment services, including weight loss medications, so it is essential to review your plan’s benefits and exclusions.
What types of weight loss injections does Aetna cover?
Aetna may provide coverage for the following weight loss injections when medically necessary and with prior authorization:
Approved for chronic weight management in adults with a BMI of 30 or greater, or 27 or greater with at least one weight-related comorbidity like type 2 diabetes, high blood pressure, or sleep apnea.
- To get and continue coverage, you’ll also need to:
- Participate in a weight management program for at least 6 months prior to starting a weight loss injection.
- Complete at least 3 months of therapy with Wegovy at a stable maintenance dose.
- Achieve a weight loss of at least 5% from baseline body weight, or maintain that weight loss.
- Participate in a weight management program for at least 6 months prior to starting a weight loss injection.
Approved for chronic weight management in adults with obesity or overweight and at least one weight-related comorbidity.
- To get and continue coverage, you’ll also need to:
- Complete at least 3 months of therapy with Wegovy at a stable maintenance dose.
- Achieve a weight loss of at least 5% from baseline body weight, or maintain that weight loss.
- Complete at least 3 months of therapy with Wegovy at a stable maintenance dose.
What types of weight loss injections does Aetna not cover?
Aetna generally does not cover weight loss injections that are:
- Not FDA-approved: Any weight loss injections not approved by the FDA for chronic weight management.
- Experimental or investigational: Medications considered experimental or investigational, lacking clinical evidence.
- Not medically necessary: Injections prescribed without meeting the established medical criteria for obesity treatment.
Eligibility criteria for Aetna coverage for weight loss injections
To qualify for Aetna’s coverage of weight loss injections, members typically need to meet the following criteria:
- Age: 18 years or older.
- BMI: A BMI of 30 or greater, or 27 or greater with at least one weight-related comorbidity.
- Prior treatment: Participation in a comprehensive weight management program that includes behavioral modification, reduced-calorie diet, and increased physical activity for at least 6 months before starting weight loss injeciton therapy.
- Documentation: Medical records from a licensed healthcare provider supporting the diagnosis and treatment history.
Does Aetna cover weight-loss medications online?
Yes, Aetna may cover weight-loss medications online, but coverage depends entirely on your specific plan and whether you meet the medical criteria. Typically, these medications are available only with prior authorization (PA) and must be prescribed as part of a chronic weight‑management program, not for cosmetic or short-term use.
How to check your coverage
1. Review your plan
- Log in to Aetna’s member portal and search for weight loss injections, such as Wegovy or Zepbound, to determine if they’re covered and whether prior authorization is required.
- Note that many Aetna plans explicitly exclude weight‑loss medications and related services entirely.
2. Consult your healthcare provider
- Schedule an appointment with a provider experienced in weight management to evaluate if you’re eligible.
- Aetna’s common clinical criteria include:
- At least 18 years of age or older
- A BMI of 30 or greater or 27 or greater plus at least one comorbidity
- Participation in a comprehensive lifestyle program for at least 6 months before starting medication.
3. Submit prior authorization
Your provider must submit a prior authorization request that includes:
- Your current BMI, medical history, and comorbidity documentation;
- Proof of participating in a structured weight-management program;
- For continuation: evidence of at least 3 months on a stable dose and at least a 5% weight loss (for Wegovy/Zepbound), or 4% for Saxenda.
Why Aetna might deny weight loss injections coverage
Aetna may deny coverage for weight loss injections for several reasons:
- Failure to meet medical criteria, such as BMI and treatment history.
- Insufficient medical records or documentation to support the need for the medication.
- The prescribed medication is not in the formulary.
- Exclusions in your plan.
- The medication is considered experimental or investigational.
Tips for improving your chances of approval for Aetna coverage
To increase your chances of getting Aetna’s approval for weight loss injections:
- Provide comprehensive documentation: Include BMI measurements, treatment history, and evidence of participation in a weight management program.
- Ensure you meet medical criteria: Make sure that all medical criteria are met, such as BMI thresholds and treatment durations.
- Work with your healthcare provider: Ensure all necessary documentation is submitted and follow up as needed.
- Understand your plan: Review your Aetna plan’s benefits and exclusions related to weight loss treatments.
How to get prior authorization from Aetna for weight loss injections
To obtain prior authorization:
- Consult your healthcare provider: Discuss the need for the medication and ensure they are willing to submit the necessary documentation.
- Submit documentation: Your provider will submit medical records and other required information to Aetna.
- Follow up: Regularly check with Aetna to track the status of your request.
- Appeal if denied: If denied, work with your provider to appeal the decision and provide additional documentation.
Next steps to get weight loss injections covered by Aetna online
To get weight loss injections covered by Aetna, start by reviewing your plan’s drug list to confirm coverage and prior authorization requirements. Then, consult with a healthcare provider who can assess your eligibility and assist with submitting the necessary documentation for prior authorization.
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.
FAQs about Aetna and weight loss injections
*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.
