How much does Mounjaro cost without insurance?

HERE'S WHAT WE'LL COVER

What is Mounjaro?

Mounjaro, the trade name for tirzepatide, is an FDA-approved prescription medication primarily indicated for managing type 2 diabetes in adults. When prescribed alongside a balanced diet and regular exercise, Mounjaro aids in regulating blood sugar levels by delaying the transit of food through the digestive system. This mechanism can contribute to weight loss by promoting prolonged satiety and reduced frequency of eating.

Although Mounjaro lacks FDA approval specifically for weight management, healthcare providers may prescribe it off-label to support weight loss efforts and weight maintenance. However, since Mounjaro's approval does not encompass the treatment of overweight or obesity, insurance coverage for this purpose may vary.

How much does Mounjaro cost without insurance? 

If you've been prescribed Mounjaro for weight loss but face challenges with insurance coverage or lack insurance altogether, you may be concerned about the out-of-pocket cost. Unfortunately, Mounjaro is known for its high price tag. At its list price, a month's supply of Mounjaro, consisting of four pre-filled pens for weekly injections, amounts to $1,023.04. This translates to $255.76 per week or a staggering $13,299.52 per year.

It's important to note that the list price reflects the amount Eli Lilly charges pharmacies and retailers for Mounjaro and may not reflect the actual retail price or incorporate potential insurance copays or discounts from Mounjaro coupons. Your final cost for Mounjaro can vary depending on factors such as your location, insurance plan, preferred pharmacy, and whether the medication is prescribed for type 2 diabetes or weight loss purposes.

How to get a prescription for Mounjaro for weight loss  

To obtain Mounjaro, a prescription medication, you must first consult with a licensed healthcare professional. Schedule an appointment, and if you have type 2 diabetes, they may prescribe Mounjaro as part of your diabetes management. Alternatively, if you're seeking Mounjaro for weight loss, they may prescribe it off-label. Off-label prescribing involves healthcare providers using their clinical judgment to prescribe a treatment for a condition not FDA-approved for that medication's use. This practice is common, especially with certain drugs.

For convenience, you might consider obtaining a Mounjaro prescription through an online telehealth service like Skinny Theory. These services connect you with licensed healthcare professionals who can review your medical history and recommend treatment during an online visit. If deemed suitable, you'll receive a prescription that you can use to obtain the medication from your local pharmacy.

Does insurance cover Mounjaro? 

If you're covered by health insurance, the cost of Mounjaro may be substantially reduced if your insurance provider covers the medication. However, coverage may vary depending on the condition for which Mounjaro is prescribed. While some insurance plans may cover it for treating type 2 diabetes, which is its FDA-approved use, they may not cover it for treating obesity alone, as this constitutes an off-label use of the medication.

To determine if your insurance offers coverage for Mounjaro, review your plan's prescription drug coverage details or contact your insurance provider directly for clarification.

Does Medicaid cover Mounjaro?

Medicaid coverage for weight loss medications can vary widely among different programs. While some Medicaid programs may cover these drugs, others may have specific requirements such as prior authorization or the trial of other treatments before approving coverage. Since Mounjaro is a newer drug, it may not be included in all Medicaid formularies.

To determine if Mounjaro is covered by your Medicaid plan, it's best to contact your state Medicaid agency directly and review your plan's drug formulary. This will provide you with accurate information regarding coverage and any associated requirements or restrictions.

Does Medicare cover Mounjaro?

Typically, Medicare prescription drug plans, including Medicare Part D, do not include coverage for weight loss medications. However, it's essential to review your plan's formulary to confirm whether Mounjaro is covered. If Mounjaro is not included in your plan's formulary, you may have the option to request an exception through your healthcare provider. This process involves working with your provider to submit a request for coverage based on your specific medical needs and circumstances.

How to get your insurance to cover Mounjaro

If you're seeking coverage for Mounjaro through your private or commercial insurance company, it's essential to understand that coverage may be limited to its FDA-approved indication for type 2 diabetes, rather than for weight loss. To explore insurance coverage options for Mounjaro, consider the following steps:

1. Consult your healthcare provider: Before initiating the process of checking insurance coverage, discuss with your doctor whether Mounjaro is a suitable medication for your medical condition. Once you receive a prescription for Mounjaro, you can proceed to explore insurance coverage options.
2. Contact your insurance provider: Reach out to your health insurance company to inquire about coverage for Mounjaro. During this process, inquire about any potential out-of-pocket expenses and whether prior authorization is required. Prior to contacting your insurance provider, review your health insurance plan's drug list, also known as a drug formulary, which is typically available in your plan information.
3. Be persistent: If your insurance plan does not initially offer coverage for Mounjaro, you may have the option to request coverage with the assistance of your healthcare provider. Eli Lilly provides a sample letter template of medical necessity that your healthcare provider can utilize to advocate for coverage. It's essential to remain persistent in your efforts to secure coverage and advocate for your healthcare needs.

Alternatives to Mounjaro 

In recent years, the landscape of GLP-1 medications for type 2 diabetes and weight loss has expanded, offering patients a variety of options. Mounjaro, along with its counterpart Zepbound, distinguishes itself by serving as a dual glucose-dependent insulinotropic polypeptide (GIP) receptor agonist and glucagon-like peptide-1 (GLP-1) receptor agonist. This unique characteristic may enhance its effectiveness in both blood sugar control and weight management. However, the choice between medications depends on individual health needs and insurance coverage. Here's a brief overview of the most common alternatives to Mounjaro:

1. Ozempic (semaglutide): Similar to Mounjaro, Ozempic is an injectable GLP-1 agonist approved for treating type 2 diabetes and can be prescribed off-label for weight loss. Clinical trials have shown that people taking Ozempic experienced an average weight loss of up to 7% of their body weight.
2. Wegovy (semaglutide): Also containing semaglutide as its active ingredient, Wegovy is FDA-approved specifically for weight management in individuals with obesity or overweight conditions, in combination with diet and exercise. Studies have demonstrated that a weekly dose of Wegovy can lead to an average weight loss of 15%.
3. Saxenda (liraglutide): Saxenda is FDA-approved for chronic weight management and has shown promising results in clinical studies, with the majority of participants experiencing a weight loss of 5–10% of their body weight within one year of treatment.