Does Aetna cover Ozempic?
From published formulary and policy documents for the plan type below. Not a decision for your member ID.
Sources last checked October 24, 2026
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Covered with restrictions. Ozempic is listed on the CVS Caremark Value Formulary dated 07/01/2026 with step therapy and quantity limit flags. Caremark prior authorization policy 5694-D approves Ozempic for type 2 diabetes when the patient has a documented A1C of 6.5 percent or higher or meets one of the other listed glucose criteria. It does not require a metformin trial, and approval runs 36 months. Weight loss is not listed as an indication in the policy. Aetna also publishes its own policies for some plans, so confirm which one applies to your plan.
Applies to: Commercial/employer default formulary (CVS Caremark Value Formulary); type 2 diabetes indication only
Source: CVS Caremark Value Formulary (07/01/2026); Caremark prior authorization policy 5694-D, 07/01/2026 (formulary); policy 5694-D (no revision date stated)
Policy details
Sources last checked October 18, 2026
Approval criteria
- Documented type 2 diabetes with at least one of: a history of A1C of 6.5 percent or higher; a 2-hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test; symptoms of high blood sugar or a hyperglycemic crisis plus a random plasma glucose of 200 mg/dL or higher; or a fasting plasma glucose of 126 mg/dL or higher after at least 8 hours of fasting. Documentation is required for each.
Source: CVS Caremark prior authorization policy 5694-D, Antidiabetic GLP-1 and GIP/GLP-1 agonists
Step therapy
This policy does not require a metformin trial before approval. A metformin fill at least 10 days before the claim can let a claim pay without prior authorization, but it is not a requirement for approval.
Source: CVS Caremark prior authorization policy 5694-D, Antidiabetic GLP-1 and GIP/GLP-1 agonists
Approval length
36 months
Source: CVS Caremark prior authorization policy 5694-D, Antidiabetic GLP-1 and GIP/GLP-1 agonists
Exclusions and limits
- Weight loss is not listed as an indication in this policy, which covers blood sugar control in type 2 diabetes and reducing major cardiovascular events.
Source: CVS Caremark prior authorization policy 5694-D, Antidiabetic GLP-1 and GIP/GLP-1 agonists
Policy
Caremark policy 5694-D; the document states no revision date
Source: CVS Caremark prior authorization policy 5694-D, Antidiabetic GLP-1 and GIP/GLP-1 agonists
What this means
The published policy lists approval criteria, step therapy, an initial approval of 36 months, and uses that are not covered.
This reflects the insurer's published formulary and policy for the plan type above. Your employer or plan may exclude weight-loss drugs or differ. Confirm with the number on your ID card.