What Insurance Covers Mounjaro - How to get Your Insurance to Cover Mounjaro

What insurance covers mounjaro? If you have insurance and are thinking about taking Mounjaro, find out if your plan will cover the drug for your particular needs. If you pay for Mounjaro fully out of your pocket, the annual cost may reach $12,000 or higher.

Adults with impaired blood sugar control can benefit from using this injectable, prescription-only drug in conjunction with a healthy diet and regular exercise. In May 2022, the FDA approved it for treating Type 2 diabetes. However, Mounjaro’s efficacy as a medicine for weight loss has now drawn notice.

What is Mounjaro?

Mounjaro (tirzepatide) is a novel medication that’s FDA-approved to assist adult patients with type 2 diabetes in lowering their blood sugar levels. It is used with exercise and a food plan for weight loss.

Although it is not currently licensed as a drug for weight loss, people with type 2 diabetes may find it helpful in losing weight. Weekly subcutaneous (under the skin) injections are administered.

This medication can be learned to be taken at home.

How Much Does Mounjaro Cost with Insurance?

Without insurance, Mounjaro costs $1,069 per month or $12,829 annually.

How Much Does Mounjaro Cost Without Insurance?

Depending on the drugstore, Mounjaro might cost anywhere from $1,000 to $1,200 per month without insurance.

Top Companies that Cover the Cost of Mounjaro

The following are some of the best companies for Mounjaro coverage:

Blue Cross Blue Shield.
UnitedHealthcare.
Aetna.
Cigna.
Kaiser Permanente.

These insurance providers are well-known for providing coverage for weight loss drugs.

Factors that Affect the Cost of Mounjaro

Various factors can impact the price of Mounjaro, such as:

Your location.
The pharmacy was chosen.
Why were you prescribed Mounjaro?
Your prescription medication discounts.
Your treatment plans.

The expenses of Mounjaro might mount up over time because there isn’t a generic version of the drug, and it is meant to be taken for an extended period.

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How to get Your Insurance to Cover Mounjaro

You might still need to provide proof of diagnosis to receive coverage for your prescription, even if your insurance plan covers Mounjaro for Type 2 diabetes. The steps listed below can help you improve your chances of having your insurance cover Mounjaro:

Consult your healthcare team: Make an appointment with your physician to go over your medical requirements, the possible advantages of Mounjaro, and the prospect of obtaining a prescription. Your medical provider must document these discussions and the course of your treatment.
Review your insurance plan’s formulary: To find out what medications your prescription plan covers, consult the formulary. You can use your plan’s “exceptions process” to request that Mounjaro be covered if it isn’t on the list of approved drugs. You will usually need to verify that the drug is medically essential and that other treatments are not as effective, though this process varies from company to company.
Get prior authorization if necessary: If Mounjaro needs prior authorization from your insurance provider, your doctor may need to confirm that you have Type 2 diabetes and provide details about your medical history and course of treatment. To prevent delays in the approval process for your prescription, they must supply the most accurate diagnosis code for your disease.
If needed, You can file an appeal if your insurance company rejects your initial request for coverage. This allows you to provide supporting paperwork, such as a statement of medical necessity or an appeal, hoping that your insurance provider would change their mind.

These are some effective ways to go about it.

How to get Insurance for Mounjaro

To receive this insurance, adhere to the guidelines provided below:

Visit the official websites of Aetna, Cigna, UnitedHealthcare, and other insurance companies that were previously mentioned.
You can visit the official Aetna website at https://www.aetna.com/individuals-families
To obtain their contact details, click “Contact us” and navigate the page.

Call them for further details on how to put this policy into effect.

Frequently Asked Questions

Below are some frequently asked questions.

Does Insurance cover Mounjaro?

Yes, you might be covered for Mounjaro if you have insurance. However, that relies on the formulary and specifications of your health plan. For instance, Mounjaro’s FDA-approved use for Type 2 diabetes may be covered by your insurance provider.

Where can I buy Mounjaro Without Insurance?

The following retailers offer Mounjaro to those without insurance:

Calibrate.
Everlywell.
LifeMD.
Plushcare.
Noom Med.

What is Mounjaro’s Price at Walmart?

A month’s supply of Mounjaro is available at Walmart Pharmacy for about $1,000. Location and any applicable savings coupons may affect the price.

Conclusion

Mounjaro helps people with type 2 diabetes control their blood sugar levels. Although the Food and Drug Administration (FDA) has not approved it for this usage, it can also aid in weight loss. To purchase Mounjaro, a person needs a doctor’s prescription.