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Is Mounjaro covered by insurance or Medicare?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on April 20, 2024.

Does Mounjaro have a $25 coupon available?

Official answer

by Drugs.com

Yes, some insurance companies may cover your prescription for Mounjaro, but this will vary based on your insurance plan and drug benefits. The manufacturer of Mounjaro offers a savings card that can lower your cost to $25 for up to a 3-month supply, if you have commercial prescription insurance.

Your insurance company may cover Mounjaro for treatment of type 2 diabetes but not for weight loss.

To find out if your drug plan will pay for Mounjaro, contact them and ask if Mounjaro is on their formulary (the list of the drugs they have approved for coverage) and which conditions it covers.

Mounjaro $25 Coupon

Eli Lilly the manufacturer of Mounjaro offers a $25 Savings Card that can lower your cost to a $25 for up to a 3-month supply, if you have commercial prescription insurance and a documented diagnosis of type 2 diabetes. Patients covered under government insurance such as Medicare or Medicaid do not qualify for the $25 savings card.

The coupon will cover 1 month (28 days and 4 pens) or 3 months (84 days and up to 12 pens).

Click here for the coupon link: Mounjaro Price Guide and Savings Coupons

The amount you pay for Mounjaro will depend upon your prescription drug coverage, deductible and copay (determined by the “tier”). Higher tiers, like tier 3 or 4, usually mean higher copays.

If you have not fully met your yearly deductible, or if the drug is not covered, you may be responsible for the full monthly cost of this drug, which may be over $1000. Coverages will vary among plans.

How do I get the Mounjaro savings card?

Eli Lilly, the manufacturer of Mounjaro offers a savings card program for eligible patients with commercial prescription drug insurance, even if your insurance plan does not cover Mounjaro. You may pay as little as $25 for up to a 3-month prescription (up to 12 pens).

Commercial insurance is the type often offered through your employer or that you buy on your own.

If you have type 2 diabetes and are an adult resident of the U.S., you may be able to save money with Mounjaro by using this savings card. You can obtain and activate the savings card on the Mounjaro website before you use it, or you can call Eli Lilly at 1-844-805-5807.

If you do not have prescription insurance or you have government-sponsored insurance (such as Medicare, Medicaid, Medicare Part D, Medigap, DoD, VA, TriCare/Champus, or any state or pharmaceutical assistance program), you are not eligible for the $25 Mounjaro prescription drug savings card.

How long does the Mounjaro savings card last?

If your insurance covers Mounjaro and you are eligible, you can use the Mounjaro savings card until Dec. 31, 2024. The savings card may be used for a maximum of up to 13 prescription fills per calendar year. There is a maximum of $1800 savings per year.

If you have commercial prescription insurance and are eligible, but your insurance does NOT cover Mounjaro, this offer is good until June 30, 2024. The savings card may be used for a maximum of up to 6 prescription fills per calendar year. There is a maximum of $3,483 savings per year.

If you do not have commercial insurance, but need assistance, you can call The Lilly Answers Center (TLAC) at 1-800-LillyRx (1-800-545-5979) for additional information on other types of payment options.

When will insurance pay for Mounjaro?

If your insurance pays for Mounjaro, it will typically only be paid for when it is prescribed for its FDA approved indication, type 2 diabetes.

Mounjaro is not approved as a weight loss medication, and insurance companies will not typically cover any cost for this use, even if your doctor writes you a prescription for weight loss (known as an “off-label” indication).

In Nov. 2023, Zepbound, which contains tirzepatide (the same active ingredient as Mounjaro) was approved for weight loss maintenance in adults. Check with your prescription plan to determine if you have insurance coverage for this medication, if needed.

Other FDA-approved options similar to Mounjaro are available for use in weight loss. Wegovy (generic name: semaglutide) is an FDA-approved for the weight loss that is similar to, but not exactly the same as Mounjaro. Semaglutide is also sold under the brand names Ozempic and Rybelsus for the treatment of type 2 diabetes in the U.S., but are not approved by the FDA for weight loss.

Related questions

How do I get insurance to cover Mounjaro?

If your doctor agrees Mounjaro is right for you, and your insurance pays for Mounjaro, you may be required to follow a “stepped therapy” plan for type 2 diabetes treatment before you are eligible for coverage. The specifics for these plans may vary among insurance companies.

Drug plans may require that you have previously had an inadequate response to several different types of 2 diabetes treatments (this is called “stepped therapy”), or experienced intolerable side effects, before you are eligible for Mounjaro treatment.

Your doctor may need to fill out a “prior authorization” form, which is paperwork submitted to the insurance company to determine your eligibility for Mounjaro. It can take several days or longer to hear back on the decision.

How much does one month of Mounjaro cost?

The retail cash price for Mounjaro is about $1,135 for a one month (28-day) supply of Mounjaro (equal to four pens) as of April 2024, but most people do not pay this price. The price you pay is dependent on your insurance coverage, deductibles and copays.

The manufacturer may be able to offer a $25 savings card or patient financial assistance, if you qualify. Online discount coupons may also help you save if you are paying cash.

Which insurance covers Mounjaro?

Your prescription drug insurance company can tell you if Mounjaro is covered under your plan. Call your insurance and ask if Mounjaro is on their formulary and which medical conditions it covers. You can usually find the number to call on the back of your card.

Eli Lilly, the manufacturer of Mounjaro offers a copay card program for patients with commercial prescription drug insurance who qualify, even if their insurance plan does not cover Mounjaro. You may pay as little as $25 for up to a 3-month supply. Contact the Mounjaro patient services support center at 844-805-5807 to learn more.

If you have state or federal government-sponsored prescription insurance, for example, Medicare Part D, Medicaid, TriCare of DOD, contact your plan to determine your eligibility for Mounjaro.

What is Mounjaro?

Mounjaro (tirzepatide) is a medicine approved by the FDA in May 2022 to help lower blood sugar in adult patients with type 2 diabetes. It is used in addition to a weight-loss diet and exercise plan.

Mounjaro is not yet approved as a weight loss medication, but it may help you lose weight if you have type 2 diabetes. It is given as a weekly subcutaneous (under the skin) injection. You, or a caregiver, can learn to administer this medicine for home use.

Learn more: Does Mounjaro work for weight loss?

Is Mounjaro available as a generic?

No, Mounjaro (generic name: tirzepatide) was first approved in 2022 and a generic option is not expected before 2036.

Mounjaro is an expensive injectable medicine used weekly to help lower blood sugar levels in adults with type 2 diabetes, but a copay savings card or coupon may help to lower your costs, if you have commercial drug insurance.

If you have further questions about how to save on your Mounjaro prescription, contact the Mounjaro patient services support center at 844-805-5807.

This is not all the information you need to know about Mounjaro (tirzepatide) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.

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