Aetna · Type 2 Diabetes

Aetna coverage for Mounjaro (Type 2 Diabetes)

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

Age 10 and older

Qualification pathways

You can qualify through any one of these.

Type 2 diabetes mellitus - adjunct to diet and exercise

All of:

Diagnosis of type 2 diabetes mellitus
Age 10 years or older

Quantity limits

2.5 mg/0.5 mL, 5 mg/0.5 mL, 7.5 mg/0.5 mL, 10 mg/0.5 mL, 12.5 mg/0.5 mL, 15 mg/0.5 mL — 2 mL (4 pre-filled single-dose pens) / 21 days; 6 mL (12 pre-filled single-dose pens) / 63 days (84-day)

Not covered when

Zepbound vials and Kwikpens under LillyDirect are excluded from this policy; however this applies to the tirzepatide product line generally
Type 1 diabetes

Policy note: This policy is primarily a weight loss policy (BMI 35 GLP-1 PA). Mounjaro's diabetes indication is referenced by FDA indication language only — no specific PA criteria details (A1C thresholds, metformin step therapy, etc.) are provided in this document for the diabetes indication. The document lists Mounjaro in the drug table and references FDA indication for T2DM. No separate diabetes PA criteria section exists. Approval duration not specified for Mounjaro diabetes in the DOA section (only OSA and weight loss DOAs are listed for tirzepatide). Mounjaro is also used in the OSA criteria section jointly with Zepbound as 'tirzepatide (Zepbound/Mounjaro)'.

Policy effective April 10, 2026 · verified June 2, 2026 · source: policy-260.html

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