Does Aetna Cover Contrave?

CVS Caremark (Aetna's PBM) uses a standardized AOM prior authorization template for Contrave and Qsymia: BMI ≥30, or ≥27 with a comorbidity, plus a documented behavioral or diet program. This template is specific to CVS's AOM management pathway and differs from, for example, OptumRx's process. Before filing, confirm your employer plan includes a weight-loss benefit — CVS Caremark cannot approve what a plan has excluded.

No. Medicare Part D statutorily excludes weight-loss agents including Contrave — this applies to all Medicare plans, including Aetna's. The 2026 GLP-1 Bridge does not cover oral AOMs. The manufacturer copay coupon also excludes Medicare members. CurAccess at approximately $99/month cash is open to Medicare patients who choose not to bill their plan.

An anti-obesity medication carve-out is an employer-elected exclusion that removes weight-loss drugs from the plan's covered benefits. Because Contrave is FDA-approved only for weight management, any Aetna plan with this carve-out will not cover it — no PA, no appeal, and no clinical documentation will change a plan-level benefit exclusion. Checking this before filing a PA saves time.

The manufacturer commercial copay coupon (as low as $0, maximum $199/month without coverage) is usable for Aetna commercial and ACA members. It explicitly excludes Medicare, Medicaid, and TRICARE. CurAccess, the cash program at approximately $99/month, is separate from the coupon and is open to all cash-paying patients including government-insured members who do not bill their plan.

Aetna Better Health administers Medicaid in several states; AOM coverage on state Medicaid is state-determined. Some states exclude anti-obesity medications entirely; others may allow certain lower-cost oral agents. There is no uniform Aetna Medicaid answer — check your specific state's Medicaid preferred drug list or call Aetna Better Health for your state.