Does Aetna cover Zepbound?
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CVS Caremark, the pharmacy benefit manager in Aetna's parent company CVS Health, removed Zepbound from its formulary on July 1, 2025 and lists Wegovy as the covered alternative. If your Aetna plan uses that formulary, Zepbound needs a formulary exception. Aetna's Zepbound policy (6192-C) sets the clinical bar at BMI 30, or 27 with a weight-related condition, plus 6 months in a weight management program.
What Aetna specifically requires
- Plans using the CVS Caremark formulary since July 1, 2025: Zepbound is non-formulary and needs an exception
- Baseline BMI of 30 or more, or 27 or more with at least one weight-related condition
- At least 6 months in a comprehensive weight management program before starting
- First approval: 8 months
- Renewal: at least 3 months on a stable maintenance dose and at least 5% loss from baseline (or keeping it); renewed for 12 months
Sources: Massachusetts GIC: CVS Caremark removes Zepbound from its formulary (Jun 10, 2025); Aetna Zepbound prior authorization policy 6192-C (Dec 19, 2024)
About Aetna coverage
- Wegovy's first approval runs 7 months and requires at least 6 months in a comprehensive weight management program before starting (policy 4774-C). Aetna Wegovy prior authorization policy 4774-C, May 1, 2024
- Zepbound's first approval runs 8 months; renewal requires at least 3 months on a stable maintenance dose and 5% weight loss from baseline (policy 6192-C). Aetna Zepbound prior authorization policy 6192-C, Dec 19, 2024
- CVS Caremark removed Zepbound from its formulary effective July 1, 2025 and named Wegovy as the covered alternative. Massachusetts GIC: CVS Caremark removes Zepbound from its formulary, Jun 10, 2025
- Aetna keeps a separate Wegovy policy for cardiovascular risk reduction (6410-C), apart from its weight-loss policy. Aetna Wegovy (cardiovascular) policy 6410-C, Mar 2024
- Wegovy supply limit: one box of 4 pens per 21 days, or 3 boxes per 63 days (policy 4774-C). Aetna Wegovy prior authorization policy 4774-C, May 1, 2024
Where to get Zepbound
Telehealth services that handle Zepbound, useful while prior auth processes or as a cash-pay alternative. We may earn a commission. See disclosure.
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Frequently asked
Does Aetna cover Zepbound?+
CVS Caremark, the pharmacy benefit manager in Aetna's parent company CVS Health, removed Zepbound from its formulary on July 1, 2025 and lists Wegovy as the covered alternative. If your Aetna plan uses that formulary, Zepbound needs a formulary exception. Aetna's Zepbound policy (6192-C) sets the clinical bar at BMI 30, or 27 with a weight-related condition, plus 6 months in a weight management program.
Does Aetna require prior authorization for Zepbound?+
Yes. Aetna requires prior authorization for Zepbound. Your prescriber submits the request with the documentation listed in the Aetna criteria on this page.