Does CVS Caremark Cover Mounjaro? Criteria, Copay, How to Appeal

CVS Caremark covers Mounjaro for type 2 diabetes on its drug list, usually with prior authorization. Mounjaro is approved for type 2 diabetes and heart risk, not weight loss, so the plan judges it on those uses.

For type 2 diabetes: Covered on formulary
Prior authorization: Required
For weight loss: Plan sponsor choice

Mounjaro facts at a glance

How long it remains in your body

Its half-life is about 5 days: after 5 d, half is gone, and after five half-lives (25 d), about 3% remains.

Weight loss in its main trial

In SURPASS-1, people with type 2 diabetes lost 7.8 kg over 40 weeks, compared with 1 kg on placebo.

Costs over time

Monthly prices in US dollars include the list price and self-pay offers, all taken from the maker's price page.

Sources: FDA label (DailyMed), healthsystemtracker.org, pricinginfo.lilly.com.

Does CVS Caremark cover Mounjaro?

Mounjaro and CVS Caremark
Medicine	Approved for	Status	Prior authorization
Mounjaro	Type 2 diabetes and heart risk	Covered on formulary	Required

Sources: pricinginfo.lilly.com, mounjaro.lilly.com, GoodRx.

The published policy

CVS Caremark handles pharmacy benefit management

Zepbound removed from the template formulary: July 1, 2025
As of October 1, 2026, Zepbound is once again a preferred option
The new-drug block for Foundayo was lifted on June 1, 2026

View the policy itself at cvshealth.com.

Sources: mass.gov, cvshealth.com.

Prior approval checklist

Diagnosis: Your chart shows type 2 diabetes, or another use of Mounjaro approved for heart risk.
Records: Recent A1C results and the diabetes drugs you have tried so far.
Your prescriber submits the prior authorization; you do not file it.

If coverage is denied: the appeal

Denial reasons and fixes
Denial reason	What to send or ask
Prior authorization missing	The plan's form includes your recent A1C and type 2 diabetes diagnosis, and your prescriber submits it.
The plan wants another drug first	The plan wants you to try certain drugs first. Find out which, and send records of earlier attempts.
The drug is not on the plan's list	Request a formulary exception and ask which GLP-1 the plan prefers instead.

The exact unmet rule appears in the denial letter.
When your prescriber files the appeal, they include chart notes that address the rule.
If the plan's appeal fails, ask for an external review by an independent reviewer.

State and plan variation

Mounjaro coverage through other plans
Plan	For type 2 diabetes	Prior authorization
Medicare	Covered by Part D plans	Required
Medicaid	Covered	Required
Cigna (Evernorth / Express Scripts)	Covered on formulary	Required
Blue Cross Blue Shield	Covered on formulary	Required
Kaiser Permanente	Covered on formulary	Required
Humana	Covered by Part D plans	Required
TRICARE	Covered with PA	Required
Navitus	Covered on formulary	Not listed
Aetna	Covered on formulary	Required
UnitedHealthcare (Optum Rx)	Covered on formulary	Required
Express Scripts	Covered on formulary	Required
Optum Rx	Covered on formulary	Required
VA (Veterans Health Administration)	Covered	Required
GEHA	Covered	Required
Ambetter (Centene)	Covered on formulary	Required
ACA Marketplace plans	Common	Required
Amerigroup (Elevance Medicaid)	Covered with PA	Required