Key takeaways
Aetna often covers metformin, but it depends on your specific insurance plan.
Because metformin is a low-cost generic drug, many plans list it as a preferred drug.
To determine whether your Aetna plan covers metformin, log in to the website and review your policy’s drug formulary, or contact your provider to inquire about prescription drug coverage.
Diabetes is one of the most common diseases worldwide, but many diabetes treatments are still costly. Metformin, a generic oral medication FDA-approved to lower blood sugar in people with Type 2 diabetes, is one of the lowest-cost options available. Many patients use insurance to help lower the out-of-pocket cost of metformin, but coverage still varies by insurance provider and specific health plan.
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Does Aetna cover metformin?
In most cases, yes, Aetna does cover generic metformin prescribed for diabetes. “In treating patients for the last 25 years, I have never witnessed insurance denials for metformin in Southeast Michigan, where I practice,” says Laura Sychta, DNP, FNP-BC, DipABLM, a board-certified doctor of nursing practice and nurse practitioner. That said, prescription drug coverage varies by specific Aetna plan.
Several factors affect whether or not an Aetna insurance policy is likely to cover metformin, including:
- Condition diagnosis
- Reason for taking it
- Formulary tier
Still, the only way to know for sure if your Aetna policy covers metformin is to contact your provider or check your plan’s drug formulary.
Condition diagnosis
Metformin is FDA-approved to treat only Type 2 diabetes. It is not approved to treat Type 1 diabetes, gestational diabetes, weight loss, or polycystic ovary syndrome (PCOS) — all common off-label uses of this medication. Any insurance policy is likely to cover a drug only for its FDA-approved purpose, so in most cases, Aetna will only cover metformin for individuals diagnosed with Type 2 diabetes.
The good news is that if you do have Type 2 diabetes, getting metformin covered by insurance rarely requires special prerequisites like prior authorization or step therapy.
Reason for taking it
Metformin is intended to be used along with lifestyle changes, such as diet and exercise, for glycemic control. “Metformin is among the recommended first treatment options for most people with Type 2 diabetes due to its safety and effectiveness at lowering blood sugar,” Dr. Sychta says.
Bottom line: Metformin often causes weight loss, and it may help improve PCOS symptoms, but it is only likely to be covered by insurance when prescribed for blood sugar management associated with Type 2 diabetes.
Formulary tier
Every Aetna insurance plan has a prescription drug formulary, which is a list of covered drugs. Within the drug list, medications are categorized into three to five tiers. Your copay depends on the tier each drug falls into, with higher drug tiers coming at a higher price.
As an example, Aetna’s Advanced Control – Student Health plan includes these five tiers:
- Tier 1: Low-cost, preferred generic drugs
- Tier 2: Non-preferred generics or preferred brand-name drugs
- Tier 3: Preferred and non-preferred brand-name drugs, plus higher-cost, non-preferred generics
- Tier 4: Non-preferred brand medications and the highest-cost, non-preferred generics
- Tier 5: Highest-cost drugs (like Ozempic), including specialty drugs
As a preferred generic, metformin is one of the lowest-cost medications for enrollees of most Aetna plans.
How much does metformin cost?
Before insurance or other financial assistance, the average retail price of metformin is $165 for 60, 500mg tablets. That comprises a one-month supply of the starting dosage, which is 500 mg twice per day. “When I treat a patient with Type 2 diabetes with metformin, it can be common to increase the dosage over time,” Dr. Sychta says. This means the annual cost of metformin can add up to thousands of dollars.
That said, not every pharmacy charges this price, and — more importantly — not every patient pays the full price for prescription drugs like metformin. The cost of metformin can vary depending on dosage, insurance coverage, your insurance plan’s copay, and even geographic location. Pharmacies ultimately set their prices, so the cost of metformin can even vary between pharmacies in the same town.
How much does metformin cost with Aetna?
That depends. Having health insurance doesn’t automatically mean you will pay nothing for metformin refills. People enrolled in Aetna health plans typically pay a set copay for prescription drugs, including metformin. The exact price of metformin with Aetna depends on your specific Aetna plan and your prescribed dosage and quantity. In some cases, you may pay more for metformin before meeting your yearly deductible.
A helpful note: Regardless of the cost of metformin with Aetna, you can save time by signing up for CVS Caremark, the mail-order pharmacy associated with Aetna.
How to check whether your Aetna plan covers metformin
Aetna prescription drug coverage depends on the plan you’re enrolled in. Your specific plan’s drug formulary should list both generic and brand-name forms of metformin, along with the tier to which they belong. This is also true for Aetna Medicare and Medicaid.
The best way to check your specific Aetna plan’s health benefits is to log in to the website (Aetna.com) or call the customer service line. If you visit the Aetna website, you can log in with the number on your health plan ID card. Use the search function or scroll down to find metformin. Alternatively, you can call the help number on the back of your insurance card. The representative will likely ask for your account and group numbers, as well as the name of the drug you have been prescribed (in this case, metformin).
How to save on metformin
Even people without insurance or with insurance plans that don’t cover metformin can still save on their diabetes medication. For instance, the cost of metformin can be reduced to as little as $5 for 60, 500-mg tablets with a SingleCare coupon.
Some people are not able to get insurance coverage for metformin because they do not have a diabetes diagnosis. If you have a metformin prescription for weight loss, cardiovascular risk reduction, or PCOS, you can still use a SingleCare prescription discount card or learn about other ways to save on weight-loss medications. You can also ask your prescriber about switching to a medication that your Aetna plan does cover or connecting you to health care financial assistance resources in your area.
- Pharmacy coverage FAQs, Aetna Inc. (2025)
- Highlights of prescribing information: METFORMIN HYDROCHLORIDE- metformin tablet, film coated, extended release, U.S. Food and Drug Administration (2018)
- 2025 Aetna Standard Plan, Aetna Inc. (2025)
- Mail order pharmacy benefits, Aetna Inc. (2025)