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Does Aetna cover Ozempic?

Many Aetna plans cover Ozempic when prescribed for Type 2 diabetes
Leandra Beabout
By | Apr. 9, 2025 Medically reviewed by Samantha Marr, DNP, APN, AGPCNP-BC, CCRN
Two autoinjectors: Does Aetna cover Ozempic?

Key takeaways

  • Aetna may cover Ozempic, but it depends on your specific insurance plan.

  • Aetna typically only covers drugs prescribed for their FDA-approved purpose. For Ozempic, that includes diabetes management but not weight loss.

  • Patients must contact Aetna directly to find out if their insurance plan covers Ozempic — and, if so, what the copay will be.

  • In addition to insurance, patients can save money on Ozempic through discount cards and coupons (like SingleCare), price comparisons, and more.

In this article:

People with Type 2 Diabetes have many treatment options these days, though not all are covered by insurance. Ozempic is a prescription weekly injection manufactured by Novo Nordisk. It is often covered by insurance when prescribed for diabetes (not weight loss). However, not all insurance plans cover Ozempic — and when it is covered, the coverage amount may vary by provider and plan. People with Aetna insurance might have their Ozempic prescription covered when prescribed for glucose control for diabetes.

Does Aetna cover Ozempic?

If you have a prescription for Ozempic and are insured under Aetna (a CVS-owned company), you might wonder: Does Aetna cover Ozempic? And if so, how much does Aetna cover the drug’s cost? The answer isn’t the same for everyone because Aetna coverage varies by plan.

Some Aetna plans do cover Ozempic. For instance, in 2024, Ozempic was covered under Aetna’s Advanced Control Plan and Standard Plan. Ozempic is listed as an Aetna-preferred drug for the Standard Control Choice with Aetna Control Specialty Formulary (the plan’s preferred drug list). That means patients insured under those plans will likely have their Ozempic prescription covered by insurance for Ozempic’s FDA-approved purpose: blood sugar management for Type 2 diabetes. 

“Insurance coverage for Ozempic (semaglutide) typically requires a diagnosis of Type 2 diabetes and may also consider factors like failure of other diabetes medications,” says Jodie Pepin, Pharm.D., the clinical pharmacy program director at Harbor Health. For instance, some insurance plans might cover generic drugs like metformin or liraglutide (brand name: Victoza) before a newer drug name like Ozempic or Mounjaro.

Ultimately, some Aetna members may get insurance coverage for Ozempic; some may not. The only way to know for sure is to check your insurance plan’s drug formulary or list of covered drugs.

Does Aetna cover Ozempic for weight loss?

In most cases, Aetna does not cover Ozempic for weight loss. Though some healthcare providers prescribe it off-label for obesity, Ozempic is not FDA-approved for weight loss. 

“Ozempic is FDA-approved for treatment of diabetes, so a patient needs to be diagnosed with diabetes to have Ozempic covered,” adds Mir Ali, MD, board-certified general surgeon, bariatric surgeon, and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California. “… In my experience, it is not covered for off-label use.”

The good news is that Wegovy, the same semaglutide injection under a different brand name, is FDA-approved for weight loss. Dr. Ali says most insurance companies cover Wegovy for patients with “a BMI of 30 alone, or a BMI of 27 with another medical condition such as diabetes or hypertension.” Dr. Pepin says some insurance plans may approve Ozempic for weight loss if Wegovy is unavailable. 

Still, drug coverage varies according to the Aetna plan. It’s a good idea to check with Aetna before assuming Ozempic or Wegovy will be covered.

How much does Ozempic cost?

Currently, the list price for Ozempic without insurance coverage is $1,351 for a one-month supply, which includes four single-dose injection pens. For those who pay full price, a year’s supply of Ozempic costs $16,212. However, the out-of-pocket cost varies depending on insurance coverage, pharmacy, and location. 

People with insurance still typically need to pay a copay, which is a fixed dollar amount, for covered prescription drugs. Copays vary by insurance company and plan. According to KFF’s 2024 employer health benefits survey, the average copay in the United States is $12 for first-tier drugs, $36 for second-tier drugs, $65 for third-tier drugs, and $128 for fourth-tier drugs. Because Ozempic is a brand-name drug, insurance plans typically place it in the second tier or higher.

How to check whether your Aetna plan covers Ozempic 

“To find out if their insurance covers Ozempic, a patient should contact their insurance provider directly or check their plan’s formulary,” says Dr. Pepin. “They can also ask their pharmacist to run a test claim or have their doctor submit a prior authorization request if coverage is uncertain.”

Dr. Ali says enrollees can also contact Aetna to find out their copay and learn whether Ozempic requires prior authorization for insurance coverage.

How to save on Ozempic

Regardless of your Aetna insurance plan, there are ways to save money on Ozempic. Here are just a few:

  • Change insurance plans. One of the best ways to save on Ozempic is to enroll in an insurance plan that covers this drug. However, Americans can only change their current health plans during the annual Open Enrollment Period or a Special Enrollment Period surrounding a qualifying life event, such as a loss of current health insurance or a change in residence.
  • Try a different pharmacy. Drug prices vary by location and pharmacy, so it’s a good idea to call pharmacies in your area to compare prices.
  • Use a SingleCare discount card. Cash payers can save by using a SingleCare coupon when paying for Ozempic. An Ozempic coupon can reduce the out-of-pocket cost from $1,351 to $811 for a single pen injector.

A word of warning: The World Health Organization has warned consumers about counterfeit Ozempic in the global supply chain. Compounded semaglutide, often mislabeled as generic Ozempic, is also risky due to potential dosing errors and contamination.

Stay alert to Ozempic offered at a suspiciously low price, as it may be a dangerous counterfeit drug. The best way to get the best price on Ozempic is to talk to your doctor about savings options and then fill your prescription at a reputable licensed pharmacy.