Employer / Commercial Insurance
Covered with requirementsNo additional clinical requirements are listed beyond the diagnosis.
Qualification pathways
You can qualify through any one of these.
Type 2 Diabetes — initial coverage
All of:
- Diagnosis of Type 2 Diabetes OR trial of one generic or preferred medication for the treatment of Type 2 Diabetes
- Not used in combination with other GLP-1 agonist-containing products
Documentation to bring
- Documentation of Type 2 Diabetes diagnosis OR documentation of trial of one generic or preferred T2DM medication
- Attestation that Mounjaro will not be used in combination with other GLP-1 agonist-containing products
Approval and renewal
- Initial approval: 12 months
- Renewal: every 12 months
- To renew, the plan looks for Renewal requires that current criteria are met, the medication is providing clinical benefit, and the member is not experiencing serious adverse events.
Not covered when
- Concurrent use with other GLP-1 agonist-containing products is not allowed
Policy note: Policy language is sparse. Step therapy requires trial of one generic or preferred T2DM medication OR a T2DM diagnosis (ambiguous 'or' — the exact intent is unclear; may mean diagnosis plus step therapy, or that diagnosis alone suffices if preferred agent is tried). No A1C threshold, no BMI requirement, and no metformin-specific trial duration are stated. Document header date is March 2019 but footer shows 'Revised: 06-01-2026'.
Policy effective June 1, 2026 · verified June 2, 2026 · source: prior-authorization-and-step-therapy-guidelines.pdf