Medicare's Coverage of Mounjaro for Type 2 Diabetes

Medicare Part D (prescription drug coverage) covers Mounjaro, but only for people with type 2 diabetes — not type 1. Your coverage depends on which Part D plan you chose during open enrollment, because each plan maintains its own formulary (list of covered drugs) and cost-sharing rules. Some plans cover Mounjaro with a copay; others require prior authorization, meaning your doctor must request permission from the insurance company before you fill the prescription. A few plans may not cover it at all, or may cover it only after you try and fail on other diabetes medications first.

Medicare Part B does not cover Mounjaro. Part B covers injectable drugs administered in a doctor's office or hospital, but Mounjaro is a self-injected medication you use at home, so it falls under Part D instead. If you have Original Medicare (Part A and B only, with no Part D plan), you have no prescription drug coverage through Medicare and would need to pay the full price out of pocket — currently around $1,000 per month — unless you find other information.

Key Takeaways

  • Medicare Part D covers Mounjaro for type 2 diabetes, but coverage rules vary by plan and may include prior authorization or step therapy requirements.
  • Your out-of-pocket cost depends on your specific Part D plan's formulary tier, copay structure, and whether you have reached your deductible or entered the coverage gap.
  • If you have Original Medicare without a Part D plan, Mounjaro is not covered and you must pay the full price unless you find manufacturer information or other programs.
  • You can check your plan's coverage by calling the plan directly, visiting its website, or using the Medicare Plan Finder tool during open enrollment.
  • If your current plan does not cover Mounjaro or charges too much, you can switch to a different Part D plan during the annual open enrollment period (October 15 to December 7).

How to Find Out What Your Specific Plan Covers

The fastest way to learn your plan's coverage is to call the customer service number on the back of your insurance card. Have your pharmacy's phone number ready, because the plan representative can often check coverage while you are on the phone and tell you the exact copay amount and whether prior authorization is needed. Ask specifically whether Mounjaro is on your plan's formulary and at what tier (usually tier 3 or 4 for brand-name GLP-1 drugs, which means higher copays).

You can also check online through your plan's website or through Medicare's Plan Finder tool at Medicare.gov. The Plan Finder lets you enter your medications and see which plans cover them and at what cost. This tool is most useful during open enrollment (October 15 to December 7 each year), when you can compare plans and switch if needed. Outside open enrollment, you are locked into your current plan unless you have a may have access to life event like moving, losing other insurance, or becoming newly may be able to access for Medicare.

Prior Authorization and Step Therapy Requirements

Many Medicare Part D plans require prior authorization before covering Mounjaro, meaning your doctor must submit a request to the insurance company and receive approval before the pharmacy will fill your prescription. This typically takes three to five business days. Your doctor's office usually handles this request, but you should follow up if you do not hear back within a week.

Some plans also use step therapy, requiring you to try and fail on a cheaper diabetes medication (usually metformin or a sulfonylurea) before the plan will cover Mounjaro. If your doctor believes step therapy is not appropriate for your medical situation, they can request an exception. This process takes longer — sometimes two to three weeks — so start it as soon as possible if you need the medication urgently.

What You Will Pay Out of Pocket

Your cost for Mounjaro depends on your plan's structure and where you are in the coverage year. Most plans charge a copay per prescription (often $50 to $150 for a brand-name drug on a higher tier), but some use coinsurance instead, meaning you pay a percentage of the drug's cost. You must also meet your plan's annual deductible before coverage begins — deductibles range from $0 to $505 in 2024, depending on the plan.

Once you have filled enough prescriptions to reach the coverage gap (also called the "donut hole"), your costs rise temporarily. In 2024, the coverage gap begins after you and your plan have spent $5,850 combined on covered drugs. During the gap, you pay 25 percent of the drug's cost until your out-of-pocket spending reaches $8,550, at which point catastrophic coverage kicks in and your copay drops to a small fixed amount. These dollar amounts change each year.

If Your Plan Does Not Cover Mounjaro or the Cost Is Too High

If your current plan does not cover Mounjaro or charges more than you can afford, you have options. During the annual open enrollment period (October 15 to December 7), you can switch to a different Part D plan that does cover it at a lower cost. Use the Medicare Plan Finder to compare plans in your area and see which ones cover Mounjaro and at what price.

Outside open enrollment, you may be able to switch plans if you have a may have access to life event: moving to a new state, losing other insurance, becoming newly may be able to access for Medicare, or experiencing a significant change in income. Contact Medicare at 1-800-MEDICARE to ask whether your situation qualifies.

You can also explore manufacturer information programs. Eli Lilly, which makes Mounjaro, offers a copay card that can reduce your out-of-pocket cost to as little as $25 per month if you have commercial insurance or Medicare Part D. Ask your doctor's office or pharmacist how to request one, or visit the Mounjaro website directly.

Other GLP-1 Drugs and Medicare Coverage

Mounjaro is not the only GLP-1 medication Medicare covers for diabetes. Ozempic (semaglutide) and Trulicity (dulaglutide) are also covered by most Part D plans, often at lower copays because they have been on the market longer. Wegovy, which is the same drug as Ozempic but marketed for weight loss, is generally not covered by Medicare for weight loss alone — Medicare does not cover weight-loss drugs — though it may be covered if prescribed for type 2 diabetes.

If Mounjaro is not covered or is too expensive, ask your doctor whether one of these alternatives might work for your diabetes. Coverage and cost vary by plan, so check your specific plan's formulary before assuming another drug will be cheaper.

Frequently Asked Questions

Does Medicare cover Mounjaro for weight loss?

No. Medicare does not cover any weight-loss medications, including Mounjaro, unless you also have type 2 diabetes. If you have diabetes and your doctor prescribes Mounjaro, the weight loss is a side effect, not the reason for coverage. Medicare Part D will cover it under the diabetes indication.

What if I cannot afford the copay even with a manufacturer coupon?

Contact your doctor's office and ask about patient information programs run by Eli Lilly. These programs can provide Mounjaro at no cost to people who meet income requirements, regardless of insurance status. Your doctor's office social worker or the pharmacy may also know of local programs or nonprofits that help with medication costs.

Can I use a GoodRx coupon instead of my Medicare Part D plan?

You can, but it is usually not worth it. Medicare rules prohibit you from using a discount card like GoodRx at the same time you use your Part D coverage — you have to choose one or the other. In most cases, your Part D copay will be lower than the GoodRx price, especially if you have already met your deductible. Compare the two prices at the pharmacy before you decide.

If I switch Part D plans, will there be a gap in my Mounjaro coverage?

Your new plan's coverage begins on January 1 if you switch during open enrollment. If you need Mounjaro before then, ask your current plan or your doctor about a bridge supply — a small quantity to cover the gap. Some plans or manufacturers will provide this if you are switching plans specifically because of drug coverage.

Does Medicare Advantage cover Mounjaro?

Yes, Medicare Advantage plans (Part C) include prescription drug coverage as part of the plan. Coverage rules for Mounjaro vary by plan, just as they do with standalone Part D plans. Check your specific Advantage plan's formulary or call the plan to confirm coverage and cost before you start the medication.