{"id":633532,"date":"2025-09-12T18:30:12","date_gmt":"2025-09-12T22:30:12","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=633532"},"modified":"2026-04-16T17:05:18","modified_gmt":"2026-04-16T21:05:18","slug":"mounjaro-assistance-for-medicare-patients","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/mounjaro-assistance-for-medicare-patients\/","title":{"rendered":"Mounjaro assistance for Medicare patients"},"content":{"rendered":"

Type 2 diabetes and obesity are two of the most prevalent health issues in the U.S., so if you\u2019ve got a drug that can treat both, it\u2019s bound to be popular. That\u2019s<\/span> Mounjaro<\/span><\/a> (tirzepatide) and other GLP-1 analogs. Mounjaro is only FDA-approved for Type 2 diabetes, but it\u2019s also helped many people lose weight, and some healthcare providers may prescribe it off-label for weight management. Either way, one glance at its average out-of-pocket costs might leave you wondering how, besides your Medicare plan, you might be able to save money. Here are some useful tips.<\/span><\/p>\n

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

Sometimes, but not always. It largely depends on why the healthcare provider has prescribed it. \u201cMedicare may cover Mounjaro when it\u2019s prescribed to treat Type 2 diabetes and the drug is on the plan\u2019s formulary,\u201d says <\/span>Afi Semenya, MD<\/span><\/a>, a physician at Boston Medical Center (BMC)<\/span>. \u201cIt is also important to note that Medicare does not cover Mounjaro when it\u2019s prescribed solely for weight loss.\u201d Eli Lilly (Moujaro\u2019s manufacturer) has developed a tirzepatide drug called Zepbound that’s specifically approved for weight loss, but Medicare typically won\u2019t cover it for that purpose.<\/span><\/p>\n

Some Medicare health insurance plans might list Mounjaro as a \u201cnon-preferred brand,\u201d which means they\u2019re more likely to cover other options. For these plans, you may need prior authorization. This is the process by which insurance companies confirm that a specific prescription drug is medically necessary. It may require the prescriber to submit additional documentation, or it might require step therapy\u2014trying other drugs first before moving to Mounjaro.<\/span><\/p>\n

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

If you were to<\/span> pay for Mounjaro completely out of pocket<\/span><\/a>, you could pay $1,355.27<\/span> for 2, 5mg\/0.5ml 0.5ml pens. However, you likely won\u2019t pay that much if you have Medicare coverage.<\/span><\/p>\n

Since every Medicare Part D plan differs, it\u2019s difficult to pinpoint exactly how much you\u2019ll pay after Medicare covers its portion. However, in 2023,<\/span> Medicare contributed over $2 billion<\/span><\/a> to 370,203 beneficiaries for their Mounjaro prescriptions. That\u2019s around $6,379 per beneficiary.<\/span><\/p>\n

You may have to pay the full amount until you reach your deductible, which can vary by plan. However, the limit for Medicare Part D deductibles is $615. After that, you\u2019ll pay 25% coinsurance. Between the deductible and copays, the federal government has<\/span> capped 2026 out-of-pocket drug costs at $2,100<\/span><\/a> for all Medicare beneficiaries.<\/span><\/p>\n

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Mounjaro assistance for Medicare patients<\/span><\/h2>\n

Even with Medicare coverage, sometimes Mounjaro can still be expensive. Whether you don\u2019t receive coverage from your Medicare plan or need help paying your deductible or coinsurance, there are reliable ways to save. \u201cPatients can therefore lower costs by choosing a Part D plan that covers Mounjaro, making sure prior authorization is completed, and asking about a tier exception when appropriate,\u201d Dr. Semenya says. \u201cBut this again depends on individual plans.\u201d Here are a few other ways.<\/span><\/p>\n

Free Mounjaro coupons<\/span><\/h3>\n

SingleCare coupons can immediately knock hundreds off the price of Mounjaro. All you have to do is<\/span> sign up<\/span><\/a>, then present your SingleCare coupon card at any participating pharmacy. You can use SingleCare even if you have Medicare Part D, but you can\u2019t use the coupons on top of your Medicare coverage. You\u2019ll have to see which option will save more money.<\/span><\/p>\n

Medicare Extra Help<\/span><\/h3>\n

This is a program for Medicare beneficiaries who need assistance paying their Medicare prescription drug coverage (Part D) premiums, deductibles, coinsurance, and other costs.To qualify, you must meet income and resource limits. If you qualify for Extra Help<\/a>, you will have a $0 deductible and pay a steeply discounted price for each prescription.<\/span><\/p>\n

Medicaid<\/span><\/h3>\n

Medicaid is another government program funded by both state and federal governments that provides financial assistance for people who need help paying their medical and prescription drug costs.<\/span> Each state sets its own eligibility requirements<\/span><\/a>, but there\u2019s typically an income limit to qualify. Any Medicare beneficiaries who enroll in Medicaid will also automatically receive Extra Help benefits.<\/span><\/p>\n

Manufacturer assistance programs<\/span><\/h3>\n

Eli Lilly has a Mounjaro savings card, and they say eligible enrollees will pay as little as $25 per prescription. However, you can\u2019t qualify for this card if you’re enrolled in Medicare Part D, Medicaid, or any other government-funded prescription assistance program. The company also has a patient assistance program called Lilly Cares, and even though it doesn\u2019t currently apply to Mounjaro, it\u2019s worth keeping an eye on in case they add it in the future.<\/span><\/p>\n

90-day prescriptions<\/span><\/h3>\n

If your insurance plan and healthcare provider allow it, you can save some money by getting a 90-day prescription instead of a one-month supply. \u201cOpting to buy the 90-day (3-month) option can also help lower costs and is convenient for those who plan to use Mounjaro for the long term,\u201d Dr. Semenya says. In fact,<\/span> a study from the <\/span>Medicare & Medicaid Research Review<\/span><\/i><\/a> found that patients who got 90-day prescriptions not only saved money but also had better medication adherence and persistence with minimal medication waste.<\/span><\/p>\n

Free samples<\/span><\/h3>\n

Some healthcare professionals may stock free samples for their patients. And while this might be a good way to get a few doses for free, it\u2019s not a long-term solution for saving money.<\/span><\/p>\n

Alternative medications<\/span><\/h3>\n

Mounjaro isn\u2019t the only GLP-1 drug available, and some others might have better prices or insurance coverage. In 2024,<\/span> the FDA approved<\/span><\/a> the first GLP-1 generics. A generic version of Victoza (liraglutide)<\/a> costs $615.99<\/span>, or about $139.29<\/span> per 18 mg\/3 mL pen with SingleCare coupons. Besides that,<\/span> Ozempic<\/span><\/a>,<\/span> Rybelsus<\/span><\/a>, and<\/span> Victoza<\/span><\/a> are all GLP-1 drugs and brand-name<\/span> Mounjaro alternatives<\/span><\/a>. These might not be less expensive, but some Medicare plans may prefer them. Additionally, metformin, glipizide, and sitagliptin are common prescription medications for managing blood sugar levels.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Type 2 diabetes and obesity are two of the most prevalent health issues in the U.S., so if you\u2019ve got a drug that can treat both, it\u2019s bound to be popular. That\u2019s Mounjaro (tirzepatide) and other GLP-1 analogs. Mounjaro is only FDA-approved for Type 2 diabetes, but it\u2019s also helped many people lose weight, and […]<\/p>\n","protected":false},"author":15,"featured_media":633533,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[15,9825],"coauthors":[8861],"class_list":["post-633532","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-medicare","tag-weight-loss","wpautop"],"acf":[],"yoast_head":"\nMounjaro assistance for Medicare patients<\/title>\n<meta name=\"description\" content=\"Does Medicare cover Mounjaro? 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