Medicare does not cover Manjaro

Manjaro is a prescription medication used to treat type 2 diabetes. Medicare Part D (prescription drug coverage) does not include Manjaro on its standard formulary — the list of drugs that Part D plans agree to cover. This means you would pay the full cost of Manjaro out of your own pocket if you use a standard Part D plan.

However, some individual Part D plans may cover Manjaro through a process called a formulary exception. You can also explore other diabetes medications that Medicare does cover, or look into patient information programs run by the drug's manufacturer.

Key Takeaways

  • Manjaro is not on the standard Medicare Part D formulary, so most Part D plans will not cover it.
  • You can ask your Part D plan to make an exception and cover Manjaro, though approval is not may provide.
  • Medicare Part B covers some injectable diabetes medications, but Manjaro is typically a Part D drug.
  • The manufacturer of Manjaro offers a patient information program that may reduce your cost if you meet income requirements.
  • Switching to a different Part D plan during open enrollment may give you access to a plan that does cover Manjaro.

Why Manjaro is not on the standard Medicare formulary

Medicare Part D plans create their own formularies based on cost and clinical need. Manjaro (tirzepatide) is a newer medication — it was approved by the FDA in 2022 — and Part D plans may not have added it to their standard lists yet. Additionally, Manjaro is expensive, and plans may prefer to cover older, less costly diabetes drugs first.

Each Part D plan makes its own decisions about which drugs to cover. This means one plan may cover Manjaro while another does not. You can check your specific plan's formulary on Medicare.gov or by calling your plan directly.

How to request a formulary exception

If your doctor believes Manjaro is the right medication for you, you can ask your Part D plan for a formulary exception. This is a formal request to cover a drug that is not on the plan's standard list. Your doctor will need to submit the request and explain why Manjaro is medically necessary for your condition.

The plan will review the request and decide within 72 hours (or up to 24 hours in urgent cases). If approved, the plan will cover Manjaro. If denied, you have the right to appeal. Your doctor can also request an expedited review if you need the medication quickly.

To start this process, contact your Part D plan's customer service number (on your insurance card) and ask for the formulary exception request form. Your doctor's office can submit it on your behalf.

Other diabetes medications Medicare Part D does cover

Medicare Part D covers many diabetes medications, including older GLP-1 receptor agonists like Trulicity and Byetta, as well as metformin, sulfonylureas, and SGLT2 inhibitors. Your doctor may recommend one of these alternatives if Manjaro is not covered or if the formulary exception is denied.

Some of these medications work similarly to Manjaro and may be equally effective for your situation. Talk with your doctor about which covered options might work for you. You can also ask your pharmacist to check your plan's formulary for specific drug names and any cost-sharing amounts (copays or coinsurance).

Manufacturer information programs for Manjaro

Eli Lilly, the company that makes Manjaro, runs a patient information program called the Lilly Cares Foundation. This program may provide Manjaro at no cost or at a reduced price if you meet certain income and insurance requirements. You do not need to be uninsured to may have access to — the program also helps people with Medicare who cannot afford their out-of-pocket costs.

To learn about the program and start the process, visit the Lilly Cares Foundation website or call 1-800-545-5979. You will need to provide information about your income and current insurance. Processing typically takes one to two weeks.

Switching Part D plans to find Manjaro coverage

During the Medicare Open Enrollment Period (October 15 to December 7 each year), you can switch to a different Part D plan. If your current plan does not cover Manjaro, you may be able to find one that does. Use the Medicare Plan Finder tool on Medicare.gov to compare plans and see which ones include Manjaro on their formulary.

When you compare plans, look at the total cost — not just whether Manjaro is covered, but also the copay amount, the plan's deductible, and whether your pharmacy is in the plan's network. A plan that covers Manjaro but charges a high copay may cost more overall than your current plan.

If you miss the Open Enrollment Period, you may still be able to switch plans if you have a may have access to life event, such as moving to a new state or losing other health coverage.

What to ask your doctor and Medicare plan

Before you pursue a formulary exception or switch plans, have a conversation with your doctor about whether Manjaro is truly the best option for you. Ask:

  • Is Manjaro the only medication that will work for my diabetes, or are there covered alternatives?
  • If Manjaro is necessary, will you submit a formulary exception request to my Part D plan?
  • What should I do if the exception is denied?

Then contact your Part D plan and ask:

  • Is Manjaro on my plan's formulary?
  • What is the process for requesting a formulary exception?
  • How long does the review take?
  • What happens if my request is denied?

Frequently Asked Questions

Can I get Manjaro covered if I have Original Medicare without Part D?

Original Medicare (Part A and Part B) does not cover most outpatient prescription drugs. You would need to enroll in a Part D plan to have any prescription coverage. If you did not enroll in Part D when you first became may be able to access, you may face a late enrollment penalty. Contact Medicare at 1-800-MEDICARE to discuss your options.

Will my Part D plan cover Manjaro if my doctor says it is medically necessary?

Not automatically. Your doctor can request a formulary exception, but the plan makes the final decision. Plans often approve exceptions when the doctor explains that other covered medications have not worked or are not appropriate for your medical situation. If denied, you can appeal.

How much does Manjaro cost without insurance?

The retail price of Manjaro varies by pharmacy and dosage, but typically ranges from several hundred to over a thousand dollars per month. This is why the manufacturer's information program and formulary exceptions are important options to explore.

Can I use a GoodRx coupon or discount card instead of my Part D plan?

You can, but it may not be cheaper. Part D plans sometimes offer lower copays than discount cards. Compare the copay your plan would charge (if Manjaro were covered) with the discount card price before deciding. You cannot use both at the same time — you must choose one.

What if I switch to a plan that covers Manjaro but it has a higher monthly premium?

Use the Medicare Plan Finder to calculate your total yearly costs under each plan, including premiums, copays, and deductibles. A higher premium might be worth it if Manjaro's copay is much lower, or it might not be. The tool will show you the estimated total cost so you can compare fairly.