What to know first
Aetna's coverage of GLP-1 weight-loss medications shifted in 2024 when most commercial PPO plans added Wegovy to Tier 3 and Zepbound to Tier 4 with PA. The PA criteria are standard for the category: BMI 30 or BMI 27 with comorbidity, plus six months of documented lifestyle modification or a prior anti-obesity medication trial. The hard part is the documentation, and that's where program selection matters.
What we considered
- In-network with Aetna commercial PPO
- Will run prior auth for Wegovy or Zepbound on Aetna
- Documents comorbidities (HTN, dyslipidemia, sleep apnea) correctly for PA
- Handles step-therapy paperwork if your Aetna plan requires it
Top pick: PlushCare
PlushCare is in-network with most Aetna commercial PPO plans and actively runs PA on Wegovy and Zepbound. The fastest from intake to PA submission, often within 24 hours.
Read the full PlushCare review →
Other strong picks
Prior authorization letter templates
If your plan requires prior authorization, these templates cover the most common GLP-1 indications. Each letter is pre-filled with the correct ICD-10 codes, clinical criteria, and supporting trial citations for this insurer.
- Obesity with comorbidity PA letter template
- Type 2 diabetes PA letter template
- Cardiovascular risk (Wegovy SELECT) PA letter template
- Sleep apnea / OSA (Zepbound) PA letter template
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