{"id":632461,"date":"2025-06-05T16:16:33","date_gmt":"2025-06-05T20:16:33","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=632461"},"modified":"2025-11-17T10:10:30","modified_gmt":"2025-11-17T15:10:30","slug":"does-blue-cross-cover-mounjaro","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-blue-cross-cover-mounjaro\/","title":{"rendered":"Does Blue Cross Blue Shield cover Mounjaro?"},"content":{"rendered":"

Mounjaro<\/a> (tirzepatide) is a brand-name prescription medication that\u2019s approved by the Food and Drug Administration (FDA) to lower blood sugar levels in people with Type 2 diabetes. Manufactured by Lilly, Mounjaro is a once-weekly injection available in <\/span>six different doses<\/span><\/a>. It\u2019s considered a glucose-dependent insulinotropic polypeptide (GIP) agonist\/glucagon-like peptide-1 (<\/span>GLP-1<\/span><\/a>) receptor agonist. Some health insurance formularies cover Mounjaro, while others list it as a nonpreferred drug.\u00a0<\/span><\/p>\n

Does Blue Cross Blue Shield cover Mounjaro?<\/span><\/h2>\n

Blue Cross Blue Shield (BCBS) coverage of Mounjaro varies by plan and the BCBS affiliate (like Anthem) selling the plan. For example, <\/span>Anthem Blue Cross Blue Shield (Upstate New York)<\/span><\/a> covers Mounjaro in most plans. <\/span>Excellus Blue Cross Blue Shield<\/span><\/a> does as well. Both list Mounjaro as a tier 2 drug with quantity limits and prior authorization required.<\/span><\/p>\n

BCBS Medicare and Medicaid plans<\/span><\/h3>\n

Medicare<\/span><\/a> and <\/span>Medicaid<\/span><\/a> coverage for Mounjaro may be different than coverage offered by private or employer-sponsored plans. For example, although Excellus Blue Cross Blue Shield covers Mounjaro in some individual and family plans, it <\/span>does not cover Mounjaro in its Medicare plans<\/span><\/a>. In contrast, <\/span>Blue Cross Blue Shield of Michigan<\/span><\/a> covers Mounjaro in all Medicare plans.<\/span><\/p>\n

Medicaid coverage varies by state. For example, <\/span>Blue Cross Blue Shield of Illinois<\/span><\/a> and <\/span>Blue Cross Complete of Michigan<\/span><\/a> do list Mounjaro as a non-preferred drug but require prior authorization.<\/span><\/p>\n

Even if your BCBS health plan covers Mounjaro, you may need to get <\/span>prior authorization<\/span><\/a> from the insurance company to confirm they\u2019ll pay for it. \u201cInsurance companies seem less and less likely to cover medications like Mounjaro due to their cost,\u201d says <\/span>Megan Horsham<\/span><\/a>, a board-certified physician who specializes in weight loss at The Sanctuary Wellness Institute. \u201cIf you do not fit BMI criteria or do not have Type 2 diabetes, your insurance might not cover them.\u201d<\/span><\/p>\n

Does Blue Cross Blue Shield cover Mounjaro for weight loss?<\/span><\/h2>\n

Blue Cross Blue Shield doesn\u2019t typically cover Mounjaro for weight loss because it\u2019s considered an <\/span>off-label<\/span><\/a> use of the drug. However, tirzepatide, the active ingredient in Mounjaro, is an FDA-approved weight loss medication under the brand name <\/span>Zepbound<\/span><\/a>.\u00a0<\/span><\/p>\n

Because insurance companies tend to only cover prescriptions for their FDA-approved use, Blue Cross Blue Shield is more likely to cover Zepbound than Mounjaro for weight loss or sleep apnea, a recently FDA-approved use for Zepbound. That being said, coverage for weight loss drugs is sometimes limited unless the patient has a comorbid condition, like <\/span>sleep apnea<\/span><\/a>, high blood pressure, or high cholesterol.<\/span><\/p>\n

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

Does Blue Cross Blue Shield cover tirzepatide?<\/span><\/h2>\n

Tirzepatide, the active ingredient in Mounjaro, <\/span>isn\u2019t available as a generic medication<\/span><\/a>, so it isn\u2019t covered by Blue Cross Blue Shield.\u00a0<\/span><\/p>\n

Some specialty pharmacies will create their own version of Mounjaro, known as <\/span>compounded tirzepatide<\/span><\/a>. Compounded drugs aren\u2019t usually covered by insurance because they aren\u2019t FDA approved, and the FDA has shared its <\/span>concerns about compounded GLP-1s<\/span><\/a> like Mounjaro, such as low-quality ingredients, contaminants, or incorrect dosing. Furthermore, now that the shortage is over, <\/span>the FDA may take action against compounding pharmacies<\/span><\/a> that compound, distribute, or dispense compounded GLP-1s.<\/span><\/p>\n

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

Without insurance, Mounjaro costs an average of $1,528 per 4, 0.5 mL of 5 mg\/0.5 mL pens. With a <\/span>Mounjaro coupon from SingleCare<\/span><\/a>, you could pay as low as $875 at CVS pharmacy instead, depending on your pharmacy and location.<\/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

\n\t\t\t\t
\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
\n\t\t\t\t\t\t
\n\t\t\t
\n\t\t\t\"CVS\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$529.19\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\"Publix\"\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$621.54\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

How much does Mounjaro cost with Blue Cross Blue Shield?<\/span><\/h2>\n

The cost of Mounjaro with Blue Cross Blue Shield health insurance varies by plan. Plans typically structure their prescription costs in one of three ways:<\/span><\/p>\n