Mounjaro Insurance Coverage: PA Criteria, Denials

Does insurance cover Mounjaro?

Which plans cover Mounjaro

Plan	For type 2 diabetes	For weight loss	Prior authorization
Medicare	Covered by Part D plans	Bridge program only	Required
Medicaid	Covered	Varies by state	Required
Cigna (Evernorth / Express Scripts)	Covered on formulary	Plan dependent	Required
Blue Cross Blue Shield	Covered on formulary	Plan dependent	Required
Kaiser Permanente	Covered on formulary	Plan dependent	Required
CVS Caremark	Covered on formulary	Plan sponsor choice	Required
Humana	Covered by Part D plans	Bridge program only	Required
TRICARE	Covered with PA	Prime and Select only	Required
Navitus	Covered on formulary	Plan sponsor choice	Not listed
Aetna	Covered on formulary	Employer option	Required
UnitedHealthcare (Optum Rx)	Covered on formulary	Plan dependent	Required
Express Scripts	Covered on formulary	Plan sponsor choice	Required
Optum Rx	Covered on formulary	Plan sponsor choice	Required
VA (Veterans Health Administration)	Covered	Covered with criteria	Required
GEHA	Covered	Covered with PA	Required
Ambetter (Centene)	Covered on formulary	Excluded	Required
ACA Marketplace plans	Common	Rare	Required
Amerigroup (Elevance Medicaid)	Covered with PA	Follows state Medicaid	Required

Prior authorization checklist

• Type 2 diabetes appears in your chart, or heart risk, which is also an approved use of Mounjaro.
• Recent A1C results.
• The diabetes medicines you have already tried.

Sources: humana.com, medicare.gov, CMS, aetna.com.

If you are denied: appealing

1. The denial letter states the exact rule that was not met, so get that letter.
2. Your prescriber files the appeal, and it includes chart notes that address that rule.
3. Should the plan's appeal not succeed, ask an independent reviewer to conduct an external review.

Differences by state and plan

An insurer may approve coverage for one state or employer plan but decline it for another.

• TRICARE covers type 2 diabetes with PA

Each state sets Medicaid. every state sets its own Medicaid rules. At present, 10 states cover GLP-1s for weight loss: Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Tennessee, Virginia and Wisconsin. See all states side by side.

Source: militaryrx.express-scripts.com.

Other options when coverage says no

Prices checked November 2026. Every price links to the page it came from.

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