{"id":627850,"date":"2024-04-17T13:39:22","date_gmt":"2024-04-17T17:39:22","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=627850"},"modified":"2025-12-09T11:00:26","modified_gmt":"2025-12-09T16:00:26","slug":"is-mounjaro-covered-by-medicaid","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/is-mounjaro-covered-by-medicaid\/","title":{"rendered":"Is Mounjaro covered by Medicaid?"},"content":{"rendered":"

Mounjaro<\/span><\/a> (tirzepatide) is an injectable medication prescribed for <\/span>Type 2 diabetes<\/span><\/a>, but some healthcare providers prescribe it <\/span>off-label<\/span><\/a> for weight loss. At first glance, Mounjaro might look pretty pricey, but its out-of-pocket costs can vary drastically based on insurance coverage, discounts, pharmacy location, and more. In limited instances, Medicaid programs may cover Mounjaro for <\/span>weight loss<\/span><\/a>, but it depends on the state, and most only cover it for diabetes treatment. Here\u2019s all the important information about Mounjaro\u2019s Medicaid coverage.\u00a0<\/span><\/p>\n

How much does Mounjaro cost?<\/span><\/h2>\n

The list price for brand-name products can be steep, and Mounjaro is no exception. Without help from a health insurance plan, Medicare Part D, or Medicaid, Mounjaro costs an average of $1,526 for 4, 5 mL pens.<\/span><\/p>\n

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Save up to 80% on Mounjaro with SingleCare<\/p>\n\t\t\t

Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.<\/p>\n\t\t\t

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\n\t\t\t\t\tMounjaro 5 mg\/0.5 mL (4 pens)\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t23666 - Hampton, VA\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
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\n\t\t\t\"Kroger\t\t\t<\/div>\n\t\t\t
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\n\t\t\t\t\t$872.48\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
\n\t\t\t
\n\t\t\t\"Harris\t\t\t<\/div>\n\t\t\t
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\n\t\t\t\t\t$872.48\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\tSee Mounjaro prices at all pharmacies<\/a>\n\t\t<\/div>\n\n\t\t<\/span><\/p>\n

Does Medicaid cover Mounjaro?<\/span><\/h2>\n

Medicaid<\/span><\/a> is a federal- and state-funded program that provides free or steeply discounted health insurance, often including coverage for prescription drugs. Over <\/span>70 million Americans<\/span><\/a> received Medicaid assistance in 2025, including prescription drug coverage for Mounjaro.<\/span><\/p>\n

Does Medicaid cover Mounjaro for diabetes?<\/span><\/h3>\n

Medicaid sometimes covers Mounjaro for Type 2 diabetes treatment. In 2022, the year Mounjaro hit the market, Medicaid dispersed nearly $30 million to help beneficiaries pay for it, <\/span>according to KFF data<\/span><\/a>.\u00a0<\/span><\/p>\n

Yet that\u2019s not necessarily a guarantee. Medicaid might cover it in some circumstances but not others. For example, <\/span>Sarah Bonza<\/span><\/a>, MD, founder of <\/span>Bonza Health<\/span><\/a>, says, \u201cI just had a 49-year-old patient with a new diagnosis of diabetes and atrial fibrillation. I tried to prescribe Mounjaro, which helps with heart failure and diabetes, but I couldn\u2019t get it covered.\u201d\u00a0<\/span><\/p>\n

Diabetes Coupons & Discount Diabetic Supplies<\/b><\/a><\/p>\n

Does Medicaid cover Mounjaro for weight loss?<\/span><\/h3>\n

That said, some people might receive assistance, but usually only if it\u2019s prescribed for diabetes, not weight management. <\/span>Legislation passed in 2003<\/span><\/a> prohibits Medicare from covering drugs prescribed specifically for weight loss, and while Medicaid has more flexibility here, not every state will cover them. Mounjaro\u2019s only on-label use is for diabetes, so Medicaid likely won\u2019t cover it for weight loss. However, some states may cover it in extremely limited situations, and many are considering <\/span>expanding coverage<\/span><\/a>.<\/span><\/p>\n

Eli Lilly markets tirzepatide under the brand name <\/span>Zepbound<\/span><\/a> as a weight-loss medication. Alex Foxman, MD, physician and medical director for <\/span>Achieve Health and Weight Loss<\/span><\/a>, says, \u201cThey are exactly the same medication with exactly the same dosing schedule.\u201d KFF data indicates that Medicaid spent around $39 million in 2022 covering Wegovy, a similar drug that\u2019s approved specifically for obesity treatment. Regardless, Medicaid beneficiaries should check with their state to see whether their plan might cover Mounjaro or Zepbound.\u00a0<\/span><\/p>\n

RELATED: <\/b>Zepbound vs. Mounjaro<\/b><\/a><\/p>\n

Costs of Mounjaro under Medicaid<\/span><\/h2>\n

All 50 states include some prescription drug coverage in their Medicaid plans. The question is <\/span>how much<\/span><\/i> coverage. Each state gets to dictate its own insurance premiums and out-of-pocket requirements, including deductibles, copays, and coinsurance. This is called cost sharing.<\/span><\/p>\n

Medicaid allows states to decide which medicines on their drug lists are \u201cpreferred\u201d or \u201cnon-preferred,\u201d and states can use these out-of-pocket requirements to push patients toward their preferred\u2014typically less expensive\u2014medications. People with incomes above 150% of the federal poverty level could pay up to 20% of the drug\u2019s cost in copays, while people at or below 150% will only pay nominal amounts.<\/span><\/p>\n

Mounjaro will likely be cheaper in states that consider it a preferred drug than in states where it\u2019s nonpreferred. Check with <\/span>your state\u2019s Department of Health<\/span><\/a> to inquire about <\/span>Medicaid cost-sharing requirements<\/span><\/a>.<\/span><\/p>\n

Factors influencing Medicaid coverage of Mounjaro\u00a0<\/span><\/h2>\n

The purpose of the prescription, or the \u201cindication,\u201d is the main factor determining whether Medicaid will cover Mounjaro. Some people received coverage for Type 2 diabetes, but not many for weight loss.\u00a0<\/span><\/p>\n

And even if a state covers Mounjaro, some may have <\/span>prior authorization requirements<\/span><\/a>. According to Dr. Bonza, these requirements might include a documented diagnosis of Type 2 diabetes mellitus and confirmation with a medical test. She also says some patients must get prior authorization every year. In certain cases, the state may request that a patient try certain preferred medications before it approves Mounjaro, a process known as step therapy. This can happen if it classifies Mounjaro as a nonpreferred option.\u00a0<\/span><\/p>\n

Right now, it appears as though most Medicaid programs might prefer more established medications. \u201cI am seeing <\/span>Ozempic<\/span><\/a> (semaglutide) approval at a higher rate than Mounjaro, even though the cost of Ozempic is higher,\u201d Dr. Foxman says. \u201cI believe that as pharmacy benefit managers (PBMs) and insurance companies better understand the power of these medications and the likely long-term overall patient cost reduction due to better outcomes, these medications will be better covered.\u201d\u00a0<\/span><\/p>\n

It\u2019s important to remember that these are relatively new drugs, and the landscape is constantly changing. Continue checking with your insurance provider to verify whether coverage has changed.\u00a0<\/span><\/p>\n

Ways to get discounts on Mounjaro<\/span><\/h2>\n

Using Medicaid or other insurance coverage is one of the best ways to reduce the cost of Mounjaro, but for people who don\u2019t have insurance or whose plans might not prefer it, there are <\/span>other ways to save<\/span><\/a>. For example, SingleCare discounts can knock over $650 off the cash price of Mounjaro\u2014and <\/span>it\u2019s free to sign up<\/span><\/a>. Members can use SingleCare if they\u2019re on Medicaid, but they can\u2019t stack the discounts on top of Medicaid coverage.<\/span><\/p>\n

RELATED: <\/b>How does SingleCare work?\u00a0<\/b><\/a><\/p>\n

Be wary of any sources that claim to be selling generic or steeply discounted Mounjaro. The <\/span>Food and Drug Administration has discovered counterfeit Ozempic<\/span><\/a> pens and is investigating counterfeit Mounjaro sales as well. When looking for ways to save on Mounjaro, be sure to get it from a licensed, reputable healthcare provider.\u00a0<\/span><\/p>\n

The SingleCare prices in this article are the most accurate at the time of publishing in ZIP code 23666 as of Dec. 9, 2025. Prices vary by pharmacy. Visit our Mounjaro coupon page<\/a> for updated Mounjaro prices near you.<\/em><\/small><\/small><\/p>\n","protected":false},"excerpt":{"rendered":"

Mounjaro (tirzepatide) is an injectable medication prescribed for Type 2 diabetes, but some healthcare providers prescribe it off-label for weight loss. At first glance, Mounjaro might look pretty pricey, but its out-of-pocket costs can vary drastically based on insurance coverage, discounts, pharmacy location, and more. In limited instances, Medicaid programs may cover Mounjaro for weight […]<\/p>\n","protected":false},"author":15,"featured_media":634014,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[4343,10298,21067],"coauthors":[8861],"class_list":["post-627850","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-brand-name-drugs","tag-diabetes","tag-glp-1-drugs","wpautop"],"acf":[],"yoast_head":"\nIs Mounjaro covered by Medicaid?<\/title>\n<meta name=\"description\" content=\"Medicaid may cover Mounjaro for diabetes, which is its approved indication. 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