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"Not medically necessary" or "step therapy required" = PA denial (you can appeal) "Excluded benefit" or "not covered" = plan exclusion (different strategy needed) WHAT'S COMING Aetna Coverage Outlook for 2026 Update: Zepbound Returns to Aetna Formularies October 1, 2026 On May 28, 2026, CVS Caremark (Aetna's PBM) announced it is adding Zepbound back to its commercial formularies as an "additional preferred option," effective October 1, 2026 (Wegovy keeps its preferred status)
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Most patients experience mild side effects, like nausea, diarrhea, constipation, or abdominal pain
Fewer flares
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