Does Aetna Cover Ozempic

Explore why Aetna may deny Ozempic, tips to secure coverage, its cost without insurance, and find answers to common questions in this insightful guide.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Does Aetna Cover Ozempic?

 

  • Coverage depends on your specific plan and the medical necessity of Ozempic for your condition.
  •  

  • Aetna typically covers Ozempic for treatment of type 2 diabetes mellitus in adults when diet and exercise alone do not sufficiently control blood sugar levels.
  •  

  • Prior authorization rather than a co-payment generally determines Ozempic coverage with Aetna. Your healthcare provider must submit supporting documentation for this process.
  •  

  • Aetna requires evidence that you have tried and failed alternative therapies such as metformin or other glucose-lowering agents before approving Ozempic.
  •  

  • Coverage may also be limited to a certain supply per prescription to control dosage and costs.

 

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Ozempic Coverage with Aetna

 

Verify Eligibility

 

  • Check your specific Aetna plan details to confirm whether Ozempic is covered under your prescription drug benefits. This information is often available in your plan's evidence of coverage or formulary.
  •  

  • Contact Aetna's customer service directly to inquire if Ozempic is listed and the specific requirements for coverage. They can provide guidance specific to your plan.

 

Consult With Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Ozempic, especially if it's for managing Type 2 diabetes. Your doctor needs to provide a diagnosis and determine if Ozempic is a suitable medication for your treatment plan.
  •  

  • Request your healthcare provider to write a prescription for Ozempic, along with any necessary supporting documentation to facilitate the approval with your insurance.

 

Obtain Prior Authorization

 

  • Check if Aetna requires prior authorization for Ozempic. Often, insurers have a process in place to ensure the medication is medically necessary, especially for high-cost drugs.
  •  

  • Work with your healthcare provider to submit a prior authorization request to Aetna. This often involves providing documentation of your medical history, diagnosis, and justification for prescribing Ozempic over other treatments.

 

Follow Up with Aetna

 

  • Monitor the status of your prior authorization request by contacting Aetna or checking your member account online. Approval times can vary, and it's important to ensure all necessary documentation has been submitted.
  •  

  • If denied, review the denial reason provided by Aetna. You may need additional documentation or may consider appealing the decision if medically justified.

 

Review Financial Considerations

 

  • Determine your out-of-pocket costs for Ozempic after receiving authorization. This includes checking your co-pay or co-insurance amounts and any applicable deductible.
  •  

  • Explore Aetna's available savings programs or manufacturer coupons that might help reduce your out-of-pocket expenses for Ozempic.

 

Pick Up Your Prescription

 

  • Once approved, fill your Ozempic prescription at a participating pharmacy. Make sure the pharmacy understands your insurance coverage details to process your claim correctly.
  •  

  • Keep records of all transactions related to your prescription for future reference or any follow-up issues with Aetna.

 

Consider Long-Term Medication Management

 

  • Discuss a long-term treatment plan with your healthcare provider, including regular monitoring of your condition and adjusting the dosage or medication as necessary.
  •  

  • Stay informed on any changes to your Aetna plan that may impact your coverage or costs for Ozempic.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Aetna Cover Ozempic

Explore why Aetna may deny Ozempic, tips to secure coverage, its cost without insurance, and find answers to common questions in this insightful guide.
Curex allergy drops unboxing

Is Ozempic Covered by Aetna

 

Does Aetna Cover Ozempic?

 

  • Coverage depends on your specific plan and the medical necessity of Ozempic for your condition.
  •  

  • Aetna typically covers Ozempic for treatment of type 2 diabetes mellitus in adults when diet and exercise alone do not sufficiently control blood sugar levels.
  •  

  • Prior authorization rather than a co-payment generally determines Ozempic coverage with Aetna. Your healthcare provider must submit supporting documentation for this process.
  •  

  • Aetna requires evidence that you have tried and failed alternative therapies such as metformin or other glucose-lowering agents before approving Ozempic.
  •  

  • Coverage may also be limited to a certain supply per prescription to control dosage and costs.

 

A weight management program tailored to you

Start with Curex

Aetna's Approved Criteria for Ozempic Coverage

 

Eligibility Criteria for Ozempic Coverage

 

  • Ozempic is covered for individuals diagnosed with Type 2 Diabetes Mellitus who require improvement in glycemic control.
  •  

  • A prescription from a licensed healthcare provider is necessary, indicating the use of Ozempic as a part of a comprehensive diabetes treatment plan.
  •  

  • Candidates must have documented evidence of previous attempts to control their diabetes through diet, exercise, and oral diabetic medications, which did not achieve the desired outcomes.

 

Criteria for Continuation of Therapy

 

  • Evidence of improved glycemic control must be documented, with an emphasis on achieving individualized HbA1c targets as determined by the healthcare provider.
  •  

  • Regular follow-up and assessment by the healthcare provider to evaluate effectiveness and any adverse effects from Ozempic therapy.
  •  

  • Adherence to the prescribed treatment regimen is required for continued coverage.

 

Combination Therapy Approval

 

  • Ozempic may be approved for use in combination with other non-injectable antidiabetic agents for individuals unable to achieve target glycemic levels on monotherapy.
  •  

  • Documentation must clearly demonstrate the necessity of combination therapy for effective diabetes management.

 

Why Aetna Might Deny Ozempic Coverage

 

Reasons Aetna Might Deny Ozempic Coverage

 

  • Aetna may deny coverage for Ozempic if the medication is not prescribed for its FDA-approved indications. Ozempic is primarily approved for managing Type 2 diabetes, so any off-label use might not be covered.
  •  

  • There might be a lack of documentation supporting the necessity of Ozempic over alternative therapies. If other medications or lifestyle interventions are considered equally effective, Aetna might not cover Ozempic.
  •  

  • If Ozempic is prescribed as the initial treatment without exploring or using other recommended first-line treatments for Type 2 diabetes, coverage might be denied.
  •  

  • In cases where Ozempic is used for weight loss without a diabetes diagnosis, Aetna might not approve coverage as it is not officially approved solely for weight loss purposes.
  •  

  • Failure to provide accurate and complete information regarding the patient's medical history and previous treatments might lead to denial of coverage for Ozempic.
  •  

  • Claims may be denied if they do not meet Aetna's specific clinical guidelines and coverage policies for Ozempic, which could include certain health criteria or treatment outcomes that need to be documented.
  •  

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Ozempic Cost without Insurance?

 

Cost of Ozempic Without Insurance

 

  • The approximate cost of Ozempic without insurance is between $800 and $900 for a month's supply. This price can vary based on the pharmacy location and any available manufacturer discounts or special pharmacy promotions.
  •  

  • It's important to note that prices can fluctuate, so checking with multiple pharmacies or online services could provide more precise current pricing.
  •  

  • Patients may also consider enrolling in patient assistance programs offered by the manufacturer, Novo Nordisk, which may provide discounts or support for eligible individuals.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Ozempic Coverage with Aetna

 

Verify Eligibility

 

  • Check your specific Aetna plan details to confirm whether Ozempic is covered under your prescription drug benefits. This information is often available in your plan's evidence of coverage or formulary.
  •  

  • Contact Aetna's customer service directly to inquire if Ozempic is listed and the specific requirements for coverage. They can provide guidance specific to your plan.

 

Consult With Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Ozempic, especially if it's for managing Type 2 diabetes. Your doctor needs to provide a diagnosis and determine if Ozempic is a suitable medication for your treatment plan.
  •  

  • Request your healthcare provider to write a prescription for Ozempic, along with any necessary supporting documentation to facilitate the approval with your insurance.

 

Obtain Prior Authorization

 

  • Check if Aetna requires prior authorization for Ozempic. Often, insurers have a process in place to ensure the medication is medically necessary, especially for high-cost drugs.
  •  

  • Work with your healthcare provider to submit a prior authorization request to Aetna. This often involves providing documentation of your medical history, diagnosis, and justification for prescribing Ozempic over other treatments.

 

Follow Up with Aetna

 

  • Monitor the status of your prior authorization request by contacting Aetna or checking your member account online. Approval times can vary, and it's important to ensure all necessary documentation has been submitted.
  •  

  • If denied, review the denial reason provided by Aetna. You may need additional documentation or may consider appealing the decision if medically justified.

 

Review Financial Considerations

 

  • Determine your out-of-pocket costs for Ozempic after receiving authorization. This includes checking your co-pay or co-insurance amounts and any applicable deductible.
  •  

  • Explore Aetna's available savings programs or manufacturer coupons that might help reduce your out-of-pocket expenses for Ozempic.

 

Pick Up Your Prescription

 

  • Once approved, fill your Ozempic prescription at a participating pharmacy. Make sure the pharmacy understands your insurance coverage details to process your claim correctly.
  •  

  • Keep records of all transactions related to your prescription for future reference or any follow-up issues with Aetna.

 

Consider Long-Term Medication Management

 

  • Discuss a long-term treatment plan with your healthcare provider, including regular monitoring of your condition and adjusting the dosage or medication as necessary.
  •  

  • Stay informed on any changes to your Aetna plan that may impact your coverage or costs for Ozempic.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Ozempic FAQ

What are the common side effects of Ozempic?

 

Common Side Effects of Ozempic

 

  • Nausea: The most common side effect, often decreasing over time.
  •  

  • Vomiting: Can occur, especially at higher doses.
  •  

  • Diarrhea: May lead to dehydration; ensure adequate fluid intake.
  •  

  • Stomach (Abdominal) Pain: Often mild but can be bothersome.
  •  

  • Constipation: Can occur; manage with diet and hydration.
  •  

  • Reduced Appetite: May assist in weight loss but monitor nutritional intake.
  •  

  • Fatigue: Generally mild; ensure rest and hydration.
  •  

  • Dizziness: Monitor blood pressure and hydration levels.
  •  

  • Injection Site Reactions: Such as redness or irritation, usually temporary.

 

Ensure to discuss persistent or severe side effects with a healthcare provider.

Can Ozempic help with weight loss?

 

How Ozempic Aids Weight Loss

 

  • Ozempic contains semaglutide, a GLP-1 receptor agonist which enhances insulin release and suppresses appetite, facilitating weight loss.
  •  

  • The medication slows gastric emptying, increasing feelings of fullness and reducing calorie intake.

 

Considerations and Benefits

 

  • Clinical studies demonstrate significant weight reduction in people taking Ozempic, often used adjunctly with diet and exercise.
  •  

  • It can also help manage blood sugar levels, making it beneficial for individuals with type 2 diabetes.

 

Potential Side Effects

 

  • Common side effects include nausea, diarrhea, and vomiting, often decreasing over time.
  •  

  • Discuss with your healthcare provider to determine suitability, considering any existing conditions.

 

How does Ozempic work for diabetes?

 

How Ozempic Works for Diabetes

 

  • **Mechanism of Action:** Ozempic is a GLP-1 receptor agonist that mimics the incretin hormone, which decreases blood sugar levels by enhancing insulin secretion.
  •  

  • **Reducing Glucagon Levels:** It lowers glucagon release when blood glucose levels are high, which helps to reduce glucose production by the liver.
  •  

  • **Slows Gastric Emptying:** By delaying stomach emptying, it reduces the rapid spikes in blood glucose after meals.
  •  

  • **Increases Satiety:** It can suppress appetite, leading to possible weight loss, which is beneficial for type 2 diabetes management.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Made in Webflow