Does Aetna cover Wegovy?
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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Coverage varies. The CVS Caremark Value Formulary (07/01/2026) lists Wegovy injection and tablets with no step therapy or quantity limit flags. Caremark policy 4774-C requires prior authorization, at least 6 months in a comprehensive weight management program, and BMI of 30 or higher (or 27 or higher with a comorbidity). Plan sponsors can still exclude weight-loss drugs entirely, so this is a default, not a guarantee. Aetna also publishes its own weight-loss policies for some plans with different criteria, so confirm which policy applies to your plan.
Applies to: Commercial/employer default formularies (Aetna Standard Plan, Caremark formularies); chronic weight management, plus CV risk reduction and MASH indications
Source: Caremark PA policy 4774-C (Wegovy) and CVS Caremark Value Formulary, July 2026
Policy details
Sources last checked October 11, 2026
Approval criteria
- Adults 18 and older: at least 6 months in a comprehensive weight management program (behavior changes, reduced-calorie diet, more physical activity) with ongoing follow-up before starting the drug.
- Baseline BMI of 30 or higher, or BMI of 27 or higher with at least one weight-related condition. The policy gives high blood pressure, type 2 diabetes and dyslipidemia as examples.
- Used together with a reduced-calorie diet and more physical activity.
- Separate criteria cover Wegovy for lowering heart risk in adults with established cardiovascular disease, for MASH with moderate to advanced fibrosis, and for ages 12 to 17.
Source: CVS Caremark prior authorization policy 4774-C, Wegovy
Quantity limits
Wegovy injection 2.4 mg: 3 mL per 21 days, or 9 mL per 63 days. Wegovy tablets: 30 tablets per 25 days, or 90 tablets per 75 days.
Source: CVS Caremark prior authorization policy 4774-C, Wegovy
Approval length
8 months for adult weight management with Wegovy injection
Source: CVS Caremark prior authorization policy 4774-C, Wegovy
Renewal criteria
- At least 3 months on a stable maintenance dose.
- Either at least 5 percent weight loss from baseline, or keeping off the first 5 percent lost.
- Continuation is approved for 12 months.
Source: CVS Caremark prior authorization policy 4774-C, Wegovy
Exclusions and limits
- Using Wegovy with another semaglutide product or another GLP-1 medicine is not recommended.
- The heart-risk indication is not available to people with type 2 diabetes.
Source: CVS Caremark prior authorization policy 4774-C, Wegovy
Policy
Caremark policy 4774-C, version P08-2025 v5
Source: CVS Caremark prior authorization policy 4774-C, Wegovy
What this means
The published policy lists approval criteria, a quantity limit, an initial approval of 8 months for adult weight management with Wegovy injection, continuation criteria, 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.