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Does Aetna cover Mounjaro?

Aetna is more likely to cover Mounjaro for Type 2 diabetes than for weight loss
Leandra Beabout
By | Jun. 5, 2025 Medically reviewed by Karen Berger, Pharm.D.
A health insurance card, a stethoscope, and medication: Does Aetna cover Mounjaro?

Key takeaways

  • Aetna may cover Mounjaro, but it depends on the specific insurance plan and condition being treated.

  • Some Aetna plans list Mounjaro as a preferred brand-name drug. However, these plans also require prior authorization before they will provide coverage.

  • Before insurance or discounts, Mounjaro costs about $1,486 per month. Insurance coverage can bring the price down dramatically, but many patients still have an out-of-pocket copay.

In this article:

Mounjaro (tirzepatide) is an injectable prescription drug that is approved by the Food and Drug Administration to lower blood sugar in people with Type 2 diabetes. Categorized as a dual GIP/GLP-1 receptor agonist, Mounjaro stimulates insulin production and suppresses appetite. Because of those effects, Mounjaro is sometimes prescribed off-label for weight loss. 

Many people with a Mounjaro prescription look to health insurance, Medicaid, or Medicare to help lower their out-of-pocket costs. Insurance often does come through if the prescription is for diabetes management, not weight loss. However, insurance coverage depends on the insurance company and plan.

Does Aetna cover Mounjaro?

There is no one-size-fits-all answer to whether Aetna, a CVS Health company, covers Mounjaro. That’s because insurance coverage varies by plan. Some Aetna enrollees receive coverage for Mounjaro. Others don’t. 

There are a few key factors that influence whether a person’s Mounjaro prescription will be covered by insurance:

  • Condition being treated: “Insurance companies typically ask for FDA-approved indications to cover [drugs], which means Mounjaro—tirzepatide—will be typically covered for Type 2 diabetes,” says Inna Melamed, Pharm.D., a functional medicine practitioner and author of Digestive Reset.
  • Prior authorization: Some, if not all, Aetna plans require prior authorization for Mounjaro. This means the Aetna plan will only cover Mounjaro if the patient’s medical provider provides documented proof that the person meets certain requirements, such as a diabetes diagnosis or concerning blood glucose levels.
  • Formulary categorization: Each Aetna insurance plan has its own drug formulary, or list of covered drugs. The formulary also categorizes drugs as either preferred or nonpreferred. Both the 2025 Aetna Standard Plan and 2025 Aetna Advanced Control Plan list Mounjaro as a preferred brand-name drug, which means it is more likely to be covered than a nonpreferred drug—but because it is a brand-name drug, enrollees may still pay more for Mounjaro than they would for a preferred generic drug.

Does Aetna cover Mounjaro for weight loss?

Aetna isn’t likely to cover Mounjaro for weight loss, especially since the active ingredient in Mounjaro is also available under the name Zepbound, which is FDA approved for weight loss, unlike Mounjaro. (This is similar to how Ozempic, a diabetes drug, is also sold under the brand name Wegovy for weight loss.)

RELATED: Zepbound vs. Mounjaro │Wegovy vs. Ozempic

“In some cases, insurance may cover Mounjaro for weight loss, even though it’s off-label,” Dr. Melamed says. “These situations include when the prescriber demonstrates other failed weight loss treatments [and] sometimes when the BMI is over 30 or over 27 with weight-related chronic conditions like high blood pressure or sleep apnea.” Still, she adds that most insurance companies are strict about covering medications solely for FDA-approved indications. 

Ultimately, the only way to know if your plan will cover Mounjaro for a non-FDA-approved use like weight loss is to call Aetna or access your Aetna drug formulary online. You can typically find this information on the back of your insurance card.

Does Aetna cover tirzepatide?

Insurance plans usually do not cover non-branded tirzepatide because the FDA does not approve it for safety and efficacy.

Tirzepatide is the active ingredient in Mounjaro. There are currently no FDA-approved generic versions of Mounjaro, Zepbound, or any other tirzepatide products. Although it was possible to get custom-mixed tirzepatide, or compounded tirzepatide, from a licensed compounding pharmacy during Mounjaro shortages, the FDA may start to take action against pharmacies and outsourcing facilities that compound, dispense, or distribute compounded tirzepatide now that the shortage is over. 

Anyone considering compounded tirzepatide should understand that non-FDA-approved drugs come with risks. Unlike FDA-approved drugs like Mounjaro or Zepbound (the only two FDA-approved tirzepatide medicines on the market), compounded tirzepatide does not undergo strict testing for safety, efficacy, purity, and quality. 

How much does Mounjaro cost?

As a brand-name prescription drug, Mounjaro isn’t cheap. The average retail price is $1,486 for a one-month (28-day) supply, which includes four single-dose weekly injection pens. That breaks down to about $371 per week or more than $17,000 annually for patients without insurance coverage or financial assistance. The actual out-of-pocket cost of Mounjaro varies based on insurance coverage, financial assistance options, pharmacy, and location. 

How much does Mounjaro cost with Aetna?

The cost of Mounjaro with Aetna varies by plan and whether or not you fill your prescription at an Aetna-preferred local pharmacy or mail-order pharmacy (such as CVS Caremark).

Many Aetna insurance plans have copays, which are fixed prices for prescription drugs after meeting the plan’s deductible. Average drug copays in the United States for enrollees of employer-sponsored plans range from $12 to $128, depending on the formulary tier, according to KFF’s 2024 Employer Health Benefits Survey. 

Medicare and Medicaid costs vary by plan as well. For example, according to Aetna’s web-based cost estimator, Aetna Medicare Prime beneficiaries in the Chicago area pay $83–$285 monthly for Mounjaro, depending on their specific Aetna Medicare Prime plan. In comparison, Aetna Better Health Premier Plan MMAI—a health plan that contracts with both Medicare and Illinois Medicaid—lists Mounjaro as a tier 2 covered drug with $0 copays for beneficiaries who meet coverage requirements and get prior authorization from their healthcare provider.

How to check whether your Aetna plan covers Mounjaro 

Remember, Mounjaro coverage depends on your specific Aetna insurance plan. The best way to determine whether your Aetna plan covers Mounjaro is to check your plan’s drug formulary. There are a few ways to find this information:

  • Find your drug formulary list in the paperwork you received when enrolling in Aetna health insurance.
  • Visit Aetna’s member website and log in or register to get drug coverage information based on your specific plan.
  • Call the company hotline at 888-792-3862 to get help and information over the phone. If you call, have your insurance card or member ID card handy since the representative will likely ask for your account and group numbers.

How to save on Mounjaro

You’re not alone if you’re struggling to afford your Mounjaro prescription. One of the easiest ways to reduce the out-of-pocket cost of Mounjaro is to use a SingleCare prescription discount card, which can lower the price to as little as $869 per month, depending on which pharmacy you use. 

There are other ways to save on Mounjaro, too. Another option is to speak to your healthcare provider about whether there are any Mounjaro alternatives that may be more affordable and just as effective. 

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