Does Medicaid Cover Mounjaro? State-by-State Rules and PA

Yes for type 2 diabetes: every state Medicaid program covers GLP-1 diabetes drugs like Mounjaro, usually with prior authorization. Only 10 states also cover GLP-1s for weight loss.

States covering weight loss: 10
Covered for type 2 diabetes: Every state
States covering in January 2026: 13
Prior authorization: Typical

Mounjaro overview

How long it remains in your body

Half-life about 5 days: once 5 d have passed, half is gone, and at 25 d, after five half-lives, about 3% is left.

Weight loss in the main trial

In the 40-week SURPASS-1 trial for type 2 diabetes, 7.8 kg was lost, compared with 1 kg on placebo.

Prices over time

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

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

Does Medicaid cover Mounjaro?

Mounjaro and Medicaid
Medicine	Approved for	Medicaid covers it in
Mounjaro	Type 2 diabetes and heart risk	Every state

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

Published policy

Diabetes GLP-1s must be covered by states
October 2025 weight loss coverage: 16 states
January 2026 weight loss coverage: 13 states
Prior authorization is needed
Changes in 2026:
- Michigan: Since January 2026, coverage follows tighter rules (effective January 1, 2026)
- Pennsylvania: Coverage ended in January 2026, and the change took effect January 1, 2026
- The pilot in Utah ended in June 2026, with the end date set at June 30, 2026
- Wisconsin: Covered, but prior authorization is needed (effective July 1, 2026)
- Massachusetts: Ended in July 2026 (effective July 3, 2026)
- Rhode Island: Coverage ended as of October 2026, with the end taking effect October 1, 2026

Read the full policy at KFF.

Sources: KFF, michigan.gov, pa.gov, medicaid-documents.dhhs.utah.gov.

Prior authorization checklist

Diagnosis: either Type 2 diabetes listed on your chart, or heart risk, another approved Mounjaro use.
Prior authorization is needed
Records needed: any diabetes drugs tried so far, plus recent A1C results.
Who submits it: Your prescriber sends the request. You do not need to handle this step.

Source: KFF.

If you are denied: the appeal

Denial reasons and fixes
Denial reason	What to send or ask
Prior authorization missing	Your prescriber sends the plan's form with your type 2 diabetes diagnosis and recent A1C results.
The plan wants another drug first	Send the records for drugs you have already tried, and ask which drugs the plan wants tried first.
The drug is not on the plan's list	Ask for a formulary exception. Find out which other GLP-1 the plan prefers.

Your denial notice names the rule that was not met. Get that notice from your Medicaid plan.
Your prescriber can resubmit the prior authorization with chart notes.
If the plan still says no, you can request a state fair hearing.

State and plan variation

Medicaid GLP-1 coverage by state
State	For weight loss	For type 2 diabetes	Prior authorization
Alabama	Not covered	Covered	Not listed
Alaska	Not covered	Covered	Not listed
Arizona	Not covered	Covered	Not listed
Arkansas	Not covered	Covered	Not listed
California	Ended January 2026	Covered	Not listed
Colorado	Not covered	Covered	Not listed
Connecticut	Not covered	Covered	Not listed
Delaware	Covered with prior authorization	Covered	Required
District of Columbia	Not covered	Covered	Not listed
Florida	Not covered	Covered	Not listed
Georgia	Not covered	Covered	Not listed
Hawaii	Not covered	Covered	Not listed
Idaho	Not covered	Covered	Not listed
Illinois	Not covered	Covered	Not listed
Indiana	Joining BALANCE, start date not set	Covered	Not listed
Iowa	Not covered	Covered	Not listed
Kansas	Covered with prior authorization	Covered	Required
Kentucky	Not covered	Covered	Not listed
Louisiana	Not covered, law allows coverage from 2027	Covered	Not listed
Maine	Not covered	Covered	Not listed
Maryland	Not covered	Covered	Not listed
Massachusetts	Ended July 2026	Covered	Required
Michigan	Covered, tighter rules since January 2026	Covered	Required
Minnesota	Covered with prior authorization	Covered	Required
Mississippi	Covered	Covered	Not listed
Missouri	Covered with prior authorization	Covered	Required
Montana	Not covered	Covered	Not listed
Nebraska	Not covered	Covered	Not listed
Nevada	Not covered	Covered	Not listed
New Hampshire	Ended January 2026	Covered	Not listed
New Jersey	Not covered	Covered	Not listed
New Mexico	Not covered	Covered	Not listed
New York	Not covered	Covered	Not listed
North Carolina	Covered with prior authorization	Covered	Required
North Dakota	Not covered	Covered	Not listed
Ohio	Not covered	Covered	Not listed
Oklahoma	Not covered	Covered	Not listed
Oregon	Not covered	Covered	Not listed
Pennsylvania	Ended January 2026	Covered	Not listed
Rhode Island	Ended October 2026	Covered	Required
South Carolina	Ended January 2026	Covered	Not listed
South Dakota	Not covered	Covered	Not listed
Tennessee	Covered with prior authorization	Covered	Required
Texas	Not covered	Covered	Not listed
Utah	Pilot ended June 2026	Covered	Required
Vermont	Not covered	Covered	Not listed
Virginia	Covered with strict service authorization	Covered	Required
Washington	Not covered	Covered	Not listed
West Virginia	Not covered	Covered	Not listed
Wisconsin	Covered with prior authorization	Covered	Required
Wyoming	Not covered	Covered	Not listed

Sources: KFF, medicaidpublications.dhss.delaware.gov, events.in.gov, kdhe.ks.gov.

If coverage says no, what else you can do

Mounjaro without coverage
Route	Who it is for	What you pay
Savings offer for Mounjaro when your plan lacks coverage	commercial plan without coverage	$499 a month

Prices checked November 2026. Every price links to its source page.

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