Is Mounjaro Covered by Medicare Part D?

What Is Mounjaro, and Who Is It For?

Mounjaro is a medication approved for type 2 diabetes and belongs to a newer class of drugs called GLP-1/GIP receptor agonists. It contains the active ingredient tirzepatide, which is administered subcutaneously once a week. Mounjaro helps lower blood sugar levels by mimicking two natural hormones that reduce appetite, slow digestion, and improve insulin sensitivity. Users who tolerate the side effects can maintain better blood glucose control with long-term use.

Mounjaro may also promote weight loss as a secondary benefit. For this reason, many healthcare providers recommend it for weight management, although this use is considered off-label and affects Medicare coverage for tirzepatide. 

Medicare only covers prescriptions for FDA-approved indications — in this case, when Mounjaro is used primarily to treat type 2 diabetes. You may qualify for coverage if you are overweight or obese in addition to being diagnosed with diabetes. Medicare can deny coverage if you take it solely for weight loss. 

How Medicare Part D Covers Prescription Drugs

Medicare Part D helps pay for both generic and brand-name prescription drugs. It’s offered to Medicare beneficiaries but is an optional plan. Therefore, coverage can vary depending on what you choose. 

Each plan has its own list of covered medications, also known as “formulary.” The formulary is organized into tiers, often categorized by price. Providers place low-cost generics in the first tier and specialty or brand-name medications on higher tiers. The higher the tier, the higher your copay.

There used to be a coverage gap, often referred to as the “donut hole,” in Medicare Part D. This means you’ll pay more for prescriptions until you and your plan reach a certain spending threshold. Medicare has since eliminated this coverage gap. In 2025, there are only three parts to Medicare Part D: the deductible phase, the initial coverage period, and the catastrophic coverage phase. Your coverage progresses through these stages, which determine how the cost of medications is shared. With catastrophic coverage, you’ll pay the lowest copay.

So, will Medicare cover Mounjaro? Medicare Part D covers only medications approved by the FDA and only when they’re prescribed for their official, approved uses. For instance, Medicare will likely cover Mounjaro for diabetes. Off-label uses, including weight loss, are typically excluded, which leaves you responsible for paying the drug’s full cost. 

Is Mounjaro Covered by Medicare Part D? 

The answer is yes. Mounjaro is often covered by Medicare Part D plans, but only if your doctor prescribes it for the treatment of type 2 diabetes. Coverage applies when it’s used to control blood sugar, not for weight loss or other purposes beyond what the FDA has approved.

Coverage can differ depending on your insurance provider, formulary, and location. Some plans completely exclude Mounjaro from the formulary, while others place it on a higher tier where you’ll pay a larger copay or coinsurance to obtain it. 

There are different ways to confirm if your plan includes Mounjaro. You can call your provider to ask or log into your insurer’s online portal. Alternatively, you can visit Medicare’s official website and click the “Find Plans” tool to compare different Part D plans and their covered medications.

Overall, Mounjaro may be covered under Medicare Part D for the management of diabetes. The amount you’ll pay depends on your plan’s formulary and coverage tier.

When Will Medicare Pay for Mounjaro?

Medicare may cover Mounjaro if it’s used for type 2 diabetes. Because it’s an expensive medication, your doctor will need to prove that it’s medically necessary by submitting key documents and going through verification steps. Here are the documents that you’ll typically need. 

Doctors typically handle the paperwork. You can call Medicare for updates regarding your coverage requests.

What Does Mounjaro Cost with Medicare?

The cost of Mounjaro on Medicare depends on several factors, including your monthly premium, copays or coinsurance, deductible, and Mounjaro’s placement in the plan’s formulary tiers.  

The retail list price of Mounjaro is over $1,079.77 per fill. With this price, the amount you have to pay every month could still be hundreds of dollars. However, costs can vary widely based on your plan and which pharmacy you use. You can call your insurer to verify if Mounjaro is included in your formulary and what your estimated out-of-pocket cost is.

Why Mounjaro May Not Be Covered (and What You Can Do)

Medicare is unlikely to cover Mounjaro when it’s prescribed off-label for conditions like obesity, sleep apnea, and prediabetes. If your request for coverage is denied, you can either file an appeal and ask your doctor to submit a prior authorization or explore alternatives that are included in the formulary, such as Ozempic, Victoza, or Trulicity. These medications are approved for type 2 diabetes and are often covered under Medicare. If medication costs are a concern, discuss cost-effective treatment options with your doctor.

How to Lower Your Mounjaro Costs on Medicare

Medicare beneficiaries can’t qualify for a manufacturer savings card, but there are other ways to cut down the cost of Mounjaro. Here are a few options you can try.

If cost remains an issue, you can explore Mounjaro alternatives, such as Trulicity, Ozempic, and Victoza.

Medicare Part D May Cover Mounjaro but Only for Diabetes

Medicare may cover Mounjaro if it’s used for type 2 diabetes, not for weight loss or other off-label purposes. Additionally, you can only request coverage if Mounjaro is included in your formulary. Otherwise, you may have to choose alternatives. 

Mounjaro can cost around $1,000 per month. Its high cost is one reason some patients struggle to stay consistent with treatment. Fortunately, there are several ways to reduce out-of-pocket expenses. You and your doctor can explore patient assistance programs, Medicare Extra Help, discount coupons, and licensed pharmacies in Canada to reduce your monthly medication bills. Ordering through licensed Canadian pharmacies can help you save up to 90% on brand-name prescriptions like Mounjaro.

Frequently Asked Questions