Does Aetna cover Zepbound?
From published formulary and policy documents for the plan type below. Not a decision for your member ID.
Sources last checked October 24, 2026
Spot an error? Report a correction
Coverage varies. Aetna's Standard Plan exclusion list (July 2026) excludes Zepbound and points to Wegovy, but Aetna's formulary updates effective October 1, 2026 list Zepbound as added in the Antiobesity class. CVS Caremark announced on May 28, 2026 that it will add Zepbound back to its commercial formularies as an additional preferred option on October 1, 2026, and plan sponsors keep discretion to customize. Caremark policy 6947-C requires at least 6 months in a comprehensive weight management program and a BMI of 30 or higher (or 27 or higher with a comorbidity), with an 8-month first approval.
Applies to: Commercial/employer default formularies; chronic weight management (OSA is a separate indication); not Medicare
Source: CVS Health: CVS Caremark GLP-1 weight management expanded coverage options (press release), 2026-05-28
Policy details
Sources last checked October 18, 2026
Approval criteria
- Adult weight reduction or maintenance: participation in a comprehensive weight management program that encourages behavioral modification, a reduced-calorie diet and increased physical activity, with follow-up for at least 6 months before drug therapy.
- Baseline BMI of 30 or higher, or 27 or higher with at least one weight-related comorbid condition (for example hypertension, type 2 diabetes or dyslipidemia).
- Obstructive sleep apnea is a separate pathway and requires a current BMI of 30 or higher.
Source: CVS Caremark prior authorization policy 6947-C, tirzepatide weight management
Quantity limits
2.5, 5, 7.5 and 10 mg pens: 4 pens (2 mL) per 21 days, or 12 pens (6 mL) per 63 days. The 21-day and 63-day periods allow refill processing within 28-day and 84-day fills.
Source: CVS Caremark prior authorization policy 6947-C, tirzepatide weight management
Approval length
8 months for weight reduction or maintenance; 6 months for obstructive sleep apnea
Source: CVS Caremark prior authorization policy 6947-C, tirzepatide weight management
Renewal criteria
- Weight management: at least 3 months of therapy at a stable maintenance dose, and a loss of at least 5 percent of baseline body weight or continued maintenance of an initial 5 percent loss (documentation required).
- Continuation approval lasts 12 months.
Source: CVS Caremark prior authorization policy 6947-C, tirzepatide weight management
Exclusions and limits
- This policy excludes vials and KwikPens, which are covered under the LillyDirect manufacturer program.
Source: CVS Caremark prior authorization policy 6947-C, tirzepatide weight management
Policy
Caremark policy 6947-C; the document states no revision date
Source: CVS Caremark prior authorization policy 6947-C, tirzepatide weight management
What this means
The published policy lists approval criteria, a quantity limit, an initial approval of 8 months for weight reduction or maintenance; 6 months for obstructive sleep apnea, 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.