Is Contrave Covered By Aetna?
Yes, when clinical criteria are met.
Contrave combines bupropion (an antidepressant) and naltrexone (used in addiction treatment) and is FDA-approved for chronic weight management in adults with obesity or overweight with at least one weight-related condition. Aetna may cover Contrave when proper documentation is provided.
Does Contrave Require Prior Authorization?
Yes, in many cases.
Authorization requests usually require:
- BMI ≥30, or ≥27 with a comorbidity (e.g., type 2 diabetes, high blood pressure)
- History of previous weight loss attempts
- Documentation that lifestyle interventions were not sufficient
Are There Coverage Restrictions?
Yes.
Restrictions may include:
- Step therapy protocols
- Plan-specific tier placement (often Tier 3 or 4)
- Limits on quantity or refill frequency
Is Contrave Covered for Adolescents?
No.
Contrave is FDA-approved for adults only. Coverage for adolescents is not typically available.
What Documentation Is Needed?
For approval, your provider should submit:
- Current BMI and medical history
- Description of weight loss efforts
- Treatment plan, dosage, and justification
- Letter of medical necessity
What If Coverage Is Denied?
Appeals can be filed with:
- Updated clinical documentation
- A revised letter of medical necessity
- History of failed or intolerant alternatives
Where to Get More Info
FAQ: Aetna and Contrave Coverage
Is Contrave covered by Aetna?
In many cases, yes. Especially if BMI criteria and medical history are well documented.
Is Contrave more affordable than injectable GLP-1 drugs?
Yes. As an oral drug, Contrave often falls into a lower formulary tier.
What does Aetna require to approve Contrave?
Prior authorization, BMI threshold, comorbidity documentation, and medical necessity.
Can I use a savings card with Aetna?
Yes. Manufacturer coupons may apply even if using commercial insurance.
What if my request is denied?
You can appeal. Include all relevant clinical documentation and provider support.
Related pages: Ozempic, Saxenda, Zepbound, Mounjaro, Qsymia
Medical Disclaimer
This page is for informational purposes only and does not constitute medical advice. Coverage varies based on plan, location, and medical necessity. Always consult your healthcare provider and Aetna representative for the most accurate information.