# Does Aetna cover Ozempic? 4 min read Written by: Amelia Willson Reviewed by: Patricia Weiser, PharmD Updated: **Aug 06, 2024** ## Key takeaways - Aetna may or may not cover Ozempic. Coverage can depend on your plan’s prescription drug coverage and whether you are taking Ozempic for type 2 diabetes or weight loss. - Aetna typically requires prior authorization before Ozempic will be covered, especially if you don’t have diabetes. - Some plans may also require that other diabetes medications, such as metformin, be tried first before starting Ozempic. ## Does Aetna cover Ozempic? Aetna’s coverage of Ozempic depends on the specific plan. Some plans we reviewed, including Aetna’s Advanced Control Plan and the Aetna Standard Plan, both cover Ozempic. However, whether Aetna covers Ozempic will depend on the specific coverage details of your plan as well as what you’re taking it for: type 2 diabetes or weight loss. When Aetna does cover Ozempic, it usually falls in their Preferred Brand drug tier, which has a higher copay than Aetna’s Preferred Generics drug tier. Prior authorization is usually required, as is step therapy. ## Do you need a prior authorization for Ozempic? Yes, you typically need prior authorization (sometimes called precertification) before Aetna will cover Ozempic, especially if you haven’t been diagnosed with type 2 diabetes. The process for prior authorization can differ between insurance plans, but it usually means your healthcare provider will need to submit paperwork to your insurance plan confirming that you meet their eligibility requirements to take Ozempic. If Aetna approves the prior authorization request, Ozempic will be covered by your plan. If they don’t, you’ll have to pay out-of-pocket for Ozempic. You can also appeal their denial. Depending on your specific Aetna plan, you may not need a prior authorization for Ozempic if the last two years of your medical records show the following: - You have been diagnosed with type 2 diabetes. - You have tried a non-GLP-1 medication for diabetes, such as metformin. - You have picked up prescriptions for diabetic supplies, such as blood glucose monitors and test strips. To see if your Aetna plan requires prior authorization for Ozempic, you can review your plan’s drug formulary (this is a list of all the drugs covered by your plan). If there is a “PA” next to Ozempic, prior authorization is required. Some Aetna plans may also require step therapy before covering Ozempic. Step therapy means that you need to try one or more “prerequisite drugs” before they will cover Ozempic. Typically, these drugs are FDA-approved to treat the same condition, but for a cheaper price. In the case of Ozempic, the prerequisite drug is metformin. If your Aetna plan requires step therapy, your healthcare provider may need to document and attest that you have tried metformin for one month and it didn’t work well for you. ## Will Aetna cover Ozempic if you don’t have diabetes? It’s possible that Aetna could cover Ozempic if you don’t have diabetes, but it’s unlikely. Ozempic has two FDA-approved indications: to improve blood sugar control in people with type 2 diabetes and/or to reduce the risk of experiencing a serious cardiovascular event in people with type 2 diabetes and heart disease. While Ozempic can lead to weight loss, it is not specifically FDA-approved for weight loss. When healthcare providers prescribe Ozempic for weight loss, it is considered an off-label prescription. Your healthcare provider can submit a coverage request to Aetna requesting that they cover Ozempic as a weight loss treatment, but, in general, health insurance companies are less likely to cover off-label prescriptions. ## How to check if your Aetna plan covers Ozempic To check if your Aetna plan covers Ozempic, call the Member Services number on the back of your insurance card. You can also contact Aetna using email or chat. You can also review your plan’s drug formulary, which includes a list of the drugs covered by your plan. To find your formulary, visit the Aetna website [here](https://www.aetna.com/individuals-families/find-a-medication.html). Select the current year under the “Choose a plan year” drop down menu. Novo Nordisk offers a free online tool called NovoCare that allows you to check your insurance coverage. Fill in your information, and the tool will share your plan’s coverage of Ozempic, which may include your estimated out-of-pocket costs. ## What if Aetna won’t cover Ozempic Sometimes, insurance plans deny prior authorization requests. If that happens to you, you can ask your healthcare provider to submit an appeal. Some insurance plans may choose not to cover Ozempic, but they will cover an alternative medication instead, such as Mounjaro or Rybelsus. Review your prescription drug coverage and ask your healthcare provider if one of these Ozempic alternatives could be a good fit for you. ## How to save on Ozempic if Aetna won’t cover it If Aetna won’t cover Ozempic, there are still ways to save on the cost of Ozempic. Websites such as GoodRx, SingleCare, and Optum Perks offer prescription discount cards for several pharmacies. And if you have a Flexible Savings Account (FSA) or Health Savings Account (HSA), you may be able to apply those funds towards Ozempic. For help understanding your options, talk to your healthcare provider and your benefits administrator. **DISCLAIMER** If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.