Does TRICARE Cover Mounjaro? Criteria, Copay, How to Appeal

TRICARE covers Mounjaro for type 2 diabetes 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 with PA
Prior authorization: Required
For weight loss: Prime and Select only

Key facts about Mounjaro

How long the drug remains in the body

With a half-life of about 5 days, half disappears after 5 d, while about 3% remains after five half-lives (25 d).

Weight loss during the 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, each taken from the maker's price page.

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

Does Tricare cover Mounjaro?

TRICARE and Mounjaro
Medicine	Approved for	Status	Prior authorization
Mounjaro	Type 2 diabetes and heart risk	Covered with PA	Required

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

Published policy

TRICARE For Life ended weight-loss coverage on August 31, 2025

Read the full policy at: militaryrx.express-scripts.com.

Source: militaryrx.express-scripts.com.

Prior authorization checklist

Diagnosis: Your chart shows type 2 diabetes or heart risk, and Mounjaro is also approved for heart risk.
Coverage with PA for type 2 diabetes
Weight loss with Prime and Select:
Records: Your recent A1C results, and the medicines for diabetes you tried earlier.
Submission: your prescriber sends the prior authorization request, not you.

Source: militaryrx.express-scripts.com.

The appeal: if you are denied

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.
The plan wants another drug first	Ask the plan which drugs it wants tried first, and send records for drugs you have already tried.
The drug is not on the plan's list	Ask for a formulary exception, and check which GLP-1 the plan would prefer you use.

The exact rule which was not met is named in the denial letter, so get it.
Your prescriber files the appeal with chart notes that answer the rule.
If the plan's own appeal fails, ask for an external review by an independent case reviewer.

Variation by state and by plan

Coverage for Mounjaro with 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
CVS Caremark	Covered on formulary	Required
Humana	Covered by Part D plans	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