Aetna/CVS Health GLP-1 Coverage

Step therapy may be required — you may need to try a lower-cost medication first.

• •Most plans require prior authorization for GLP-1s.
• •Step therapy often requires failing a first-line medication before approval.
• •Savings cards can significantly reduce copays even during PA process.
• •Foundayo coverage is under review; check with Aetna directly for updates.

1. 1.Submit a letter from your doctor stating medical necessity, including BMI and comorbidities.
2. 2.Use the CVS Health Savings Card to reduce out-of-pocket costs even if PA is pending.
3. 3.Call Aetna's specialty pharmacy team to confirm formulary status before starting treatment.

1. 1.Request a peer-to-peer review with a medical director if denied.
2. 2.Include clinical evidence like HbA1c levels and weight history in your appeal.
3. 3.Submit a second opinion letter from an endocrinologist or obesity specialist.

• Does Aetna Cover GLP-1 Medications in 2026? Ozempic, Wegovy, Foundayo
• Prior Authorization for Medications: How to Get Approved in 2026
• Insurance Stopped Covering Your GLP-1 in 2026: What to Do Next