Is Saxenda Covered By Aetna?
Yes, but specific criteria must be met.
Saxenda (liraglutide) is FDA-approved for chronic weight management in adults and adolescents with obesity or those who are overweight with a weight-related condition. Aetna may provide coverage when policy requirements are fulfilled.
Does Saxenda Require Prior Authorization?
Yes.
Aetna typically requires prior authorization. Documentation should include:
- BMI of ≥30, or ≥27 with a qualifying comorbidity (e.g., high blood pressure, type 2 diabetes)
- Past history of structured weight loss programs
- Proof that lifestyle changes alone were unsuccessful
- Prescribed dosage and treatment duration
Are There Coverage Restrictions?
Yes.
Restrictions may include:
- Quantity limits per month
- Initial authorization typically limited to 12 weeks
- Required demonstration of at least 4% weight loss to continue coverage
Is Saxenda Covered for Adolescents?
Yes, in some cases.
Aetna may cover Saxenda for adolescents aged 12–17 with a BMI at or above the 95th percentile and at least one weight-related health condition.
What Documentation Is Needed?
Your healthcare provider will need to submit:
- Current BMI and medical history
- Description of weight loss efforts and outcomes
- Justification for Saxenda use, especially for adolescents
- Treatment goals and follow-up plan
What If Coverage Is Denied?
You may appeal with:
- Updated clinical documentation
- Letter of medical necessity
- Supporting records of failed alternative therapies
Where to Get More Info
FAQ: Aetna and Saxenda Coverage
Does Aetna cover Saxenda for weight loss?
Yes, if documentation supports medical necessity and criteria are met.
Is prior authorization required?
Yes. Documentation must include BMI, medical history, and past treatment attempts.
Can adolescents be approved for Saxenda?
Possibly. Aetna may approve for teens aged 12–17 with severe obesity and comorbidities.
What if coverage is denied?
An appeal can be submitted with updated medical records and a detailed necessity statement.
How is Saxenda different from Ozempic?
Saxenda is specifically approved for weight management; Ozempic is approved primarily for type 2 diabetes.
Related pages: Ozempic, Zepbound, Mounjaro, Qsymia, Contrave
Medical Disclaimer
This page is for informational purposes only and does not constitute medical advice. Coverage varies by plan, location, and medical necessity. Consult your doctor and Aetna plan administrator for the most accurate information.