{"id":628811,"date":"2024-07-02T16:32:03","date_gmt":"2024-07-02T20:32:03","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=628811"},"modified":"2025-12-10T11:28:03","modified_gmt":"2025-12-10T16:28:03","slug":"does-medicare-cover-mounjaro","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-mounjaro\/","title":{"rendered":"Does Medicare cover Mounjaro?"},"content":{"rendered":"

Mounjaro<\/span><\/a> is a popular brand-name medication approved by the Food and Drug Administration (FDA) to improve blood sugar control in people with Type 2 diabetes when used with diet and exercise. One common side effect of Mounjaro is weight loss, which is why it may sometimes be prescribed <\/span>off-label<\/span><\/a> (for a non-FDA-approved use) for that purpose. Tirzepatide, the active ingredient of Mounjaro, is approved for weight loss under the brand name <\/span>Zepbound<\/span><\/a>.\u00a0<\/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 Medicare pay for Mounjaro?<\/span><\/h2>\n

Medicare Part D may cover Mounjaro, but a number of factors come into play. Insurance companies decide which medications to cover on their drug formularies (lists of covered drugs). Even when a single insurance company offers multiple plans, some of those plans may cover Mounjaro while others may not.<\/span><\/p>\n

One of the main factors determining Medicare coverage of Mounjaro is the beneficiary\u2019s reason for taking it. Insurance is more likely to cover medication for FDA-approved indications. In the case of Mounjaro, it is only FDA approved for Type 2 diabetes. Still, it may be beneficial for patients trying to lose weight or treat obstructive sleep apnea, which are considered off-label indications for Mounjaro.<\/span><\/p>\n

RELATED: <\/b>Is Mounjaro insulin?<\/b><\/a><\/p>\n

\u201cTirzepatide works in your body by targeting two important hormones called glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1),\u201d says <\/span>Alyssa M. Wozniak<\/span><\/a>, Pharm.D., assistant dean for clinical affairs, outreach, and special projects at the School of Pharmacy at D\u2019Youville University. \u201cBy targeting these hormones, Mounjaro helps your body release more insulin when your blood sugar is high. This helps lower your blood sugar levels and reduces the amount of another hormone called glucagon, which can raise blood sugar levels.\u201d<\/span><\/p>\n

Mounjaro also slows gastric emptying so you feel full longer, according to <\/span>Sarah Bonza<\/span><\/a>, MD, of Bonza Health. Studies have shown that people who take Mounjaro experience significant weight loss.<\/span><\/p>\n

Does Medicare cover Mounjaro for Type 2 diabetes?<\/span><\/h3>\n

Yes, Medicare may cover Mounjaro for Type 2 diabetes. However, it may be considered a \u201cnon-preferred\u201d medication with some Medicare Part D plans. This non-preferred status could require you to take extra steps before your plan will pay for Mounjaro. For example, your healthcare provider may need to provide <\/span>prior authorization<\/span><\/a> to show that it is medically necessary. Or, you may be asked to try an alternative, cheaper medication first, a restriction known as <\/span>step therapy<\/span><\/a>.<\/span><\/p>\n

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

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

Current law prohibits Medicare from covering drugs prescribed solely for weight loss. However, Medicare coverage of GLP-1 medications like Mounjaro and <\/span>Ozempic<\/span><\/a> may change starting in 2026.<\/span><\/p>\n

On Nov. 6,\u00a0 2025, President Donald Trump <\/span>announced<\/span><\/a> that the manufacturer of Mounjaro, Eli Lilly and Company, agreed to lower the prices that Americans pay for popular GLP-1 medications. For about 10% of Medicare beneficiaries, GLP-1 coverage may include obesity, not just Type 2 diabetes. However, neither the White House nor the Centers for Medicare and Medicaid Services has made an official announcement stating the exact number of eligible beneficiaries, what the eligibility criteria are, and when coverage will start.\u00a0<\/span><\/p>\n

Weight Loss Coupons & Resources<\/b><\/a><\/p>\n

Does Medicare cover Mounjaro for sleep apnea?<\/span><\/h3>\n

Medicare isn\u2019t likely to cover Mounjaro for sleep apnea, but it may cover Zepbound, which has the same active ingredient (tirzepatide) and is <\/span>FDA approved for obstructive sleep apnea<\/span><\/a>.\u00a0<\/span><\/p>\n

RELATED: <\/b>What to know about switching from Zepbound to Mounjaro<\/b><\/a><\/p>\n

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

Without insurance or discounts, Mounjaro costs an average of $1,529 for four 5 mg\/0.5 mL pens, which is about a one-month supply. With a SingleCare prescription discount card or coupon, you could pay $875 instead, depending on your choice of pharmacy and location. You should note that you cannot use your Medicare Part D plan and SingleCare card together for a single prescription.\u00a0<\/span><\/p>\n

RELATED: <\/b>Is Mounjaro covered by Medicaid?<\/b><\/a><\/p>\n

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

If your Medicare Part D plan covers Mounjaro, it will be assigned a tier number. The higher the tier, the higher the copay or coinsurance. Copays and coinsurance vary by plan.\u00a0\u00a0<\/span><\/p>\n

If you\u2019re one of the Medicare beneficiaries who would benefit from the potential Medicare savings on GLP-1 medications in 2026, you may pay as little as $50 per month for Mounjaro. Ultimately, however, the cost of Mounjaro with Medicare depends on your plan\u2019s deductible and co-insurance or copay.\u00a0<\/span><\/p>\n

Nonetheless, federal law <\/span>limits your out-of-pocket expenses<\/span><\/a> to no more than $2,100 for all of your Part D covered prescriptions in 2026. This amount includes your deductible and any copays or coinsurance. It does not include your plan premium or any out-of-pocket costs incurred when using your SingleCare discount card instead of your Part D plan.<\/span><\/p>\n

You can compare the out-of-pocket costs for Mounjaro by plan using the <\/span>Medicare website<\/span><\/a>. Enter your ZIP code, any medications you\u2019re taking, including Mounjaro, and up to five local pharmacies. Click \u201cView drugs and their costs\u201d to compare the cost of your prescriptions at different pharmacies by plan.<\/span><\/p>\n

How to check whether your Medicare plan covers Mounjaro<\/span><\/h2>\n

The best way to determine whether your Medicare Part D plan covers Mounjaro is to contact your plan directly or check its online formulary. If your formulary indicates that prior authorization or step therapy is required, contact your healthcare provider and let them know.<\/span><\/p>\n

What to do if Medicare denies Mounjaro coverage<\/span><\/h2>\n

If Medicare denies coverage of Mounjaro, be sure to ask why. Sometimes coverage is denied because of clerical errors. If Medicare denies coverage of Mounjaro due to other reasons, contact your healthcare provider. They can help explain the reason and maybe even request a formulary exemption from the insurance company if they determine that Mounjaro is the most suitable medication for your needs.\u00a0<\/span><\/p>\n

If a formulary exemption isn\u2019t an option, your healthcare provider can suggest <\/span>Mounjaro alternatives<\/span><\/a> that may be covered by Medicare, or you can file an appeal of the denial.<\/span><\/p>\n

There are <\/span>ways to save on Mounjaro<\/span><\/a> if you end up paying out of pocket. With a <\/span>SingleCare coupon for Mounjaro<\/span><\/a>, for example, you could save over $650 per month.\u00a0\u00a0<\/span><\/p>\n

RELATED: <\/b>Mounjaro assistance for Medicare patients<\/b><\/a><\/p>\n

The SingleCare prices in this article are the most accurate at the time of publishing in ZIP code 23666 as of Dec. 3, 2025. Prices vary by pharmacy. Visit our <\/span><\/i>Mounjaro coupon page<\/span><\/i><\/a> for updated Mounjaro prices near you.<\/span><\/i><\/small><\/small><\/p>\n","protected":false},"excerpt":{"rendered":"

Mounjaro is a popular brand-name medication approved by the Food and Drug Administration (FDA) to improve blood sugar control in people with Type 2 diabetes when used with diet and exercise. One common side effect of Mounjaro is weight loss, which is why it may sometimes be prescribed off-label (for a non-FDA-approved use) for that […]<\/p>\n","protected":false},"author":15,"featured_media":634015,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[4343,10298,21067,15],"coauthors":[21058],"class_list":["post-628811","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-brand-name-drugs","tag-diabetes","tag-glp-1-drugs","tag-medicare","wpautop"],"acf":[],"yoast_head":"\nDoes Medicare cover Mounjaro?<\/title>\n<meta name=\"description\" content=\"Medicare may cover Mounjaro if prescribed for an FDA-approved indication. 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