Skip to content

BCBS Mississippi

Does BCBS Mississippi cover Mounjaro?

Yes. BCBS Mississippi covers Mounjaro for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy documents

  • Employer: Covered (preferred drug). See the qualification pathways below.
  • ACA Marketplace: Covered (preferred drug). See the qualification pathways below.

Earliest policy review June 2, 2026. How we verify · Check your exact plan

Full requirements: Mounjaro for Type 2 Diabetes (2 plan types)

Applies to Employer plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial approval for T2DM

All of:

  • Individual is being treated as an adjunct to diet and exercise for a diagnosis of type 2 diabetes
  • Diagnosis confirmed by lab tests (e.g., A1C ≥ 6.5%)
  • Individual is new to therapy
  • Individual will NOT use the requested agent in combination with a DPP-4 containing agent
  • Individual will NOT use the requested agent in combination with another GLP-1 receptor agonist
  • Individual does NOT have any FDA labeled contraindications to the requested agent

Continuation of therapy

All of:

  • Individual is being treated as an adjunct to diet and exercise for a diagnosis of type 2 diabetes
  • Diagnosis confirmed by lab tests (e.g., A1C ≥ 6.5%)
  • Requested medication is eligible for continuation of therapy
  • Individual will NOT use the requested agent in combination with a DPP-4 containing agent
  • Individual will NOT use the requested agent in combination with another GLP-1 receptor agonist
  • Individual does NOT have any FDA labeled contraindications to the requested agent

Plus any one of:

  • Documentation that the individual has been treated with the requested medication within the past 90 days
  • Prescriber states the individual has been treated with the requested medication within the past 90 days and is at risk if therapy is discontinued

Documentation to bring

  • Lab test results confirming T2DM diagnosis (e.g., A1C ≥ 6.5%) or medical records
  • For continuation: documentation of treatment with requested medication within the past 90 days, OR prescriber attestation of same with clinical risk statement

Approval and renewal

  • Renewal: For continuation, ONE of the following: documentation that the individual has been treated with the requested medication within the past 90 days, OR prescriber states the individual has been treated with the requested medication within the past 90 days and is at risk if therapy is discontinued.

Not covered when

  • Combination use with DPP-4 containing agents (e.g., Glyxambi, Januvia, Janumet, Jentadueto, Kazano, Kombiglyze, Nesina, Onglyza, Tradjenta)
  • Combination use with another GLP-1 receptor agonist
  • FDA labeled contraindications to the requested agent
  • Use of samples will not be considered current or stable therapy

Exceptions

  • State Health Plan (State and School Employees): Prescription drug may be covered under a prescription drug benefit plan administered by the State Health Plan's Pharmacy Benefit Manager. PA requests must be submitted to the Plan's PBM (CVS Caremark) at https://www.dfa.ms.gov/cvs-caremark
  • Structural Steel Self-Insured Group (FID#: 89805, Formulary: BCBSMS COMM-CUSTOM STEEL): Effective 06/16/2025, all GLP-1 agonist medications are covered without Prior Authorization.

Policy note: Effective 04/01/2026, review at the pharmacy is required for new start GLP-1 agonist prescriptions. Prior authorization is required for members with type 2 diabetes not treated with an oral antidiabetic agent. The metformin trial requirement was removed effective 04/01/2026. The policy applies to Mounjaro, Ozempic, Rybelsus, and Trulicity collectively under the same criteria. Byetta, Bydureon, and Victoza are considered not medically necessary as other formulary options exist. BCBSMS determines medication trial and adherence by pharmacy claims data over the preceding 12 months.

Policy effective April 1, 2026 · verified July 26, 2026 · source: Policy 231 · View policy document (PDF)

Applies to ACA Marketplace plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial therapy for T2DM

All of:

  • Adjunct to diet and exercise for type 2 diabetes diagnosis
  • A1C ≥ 6.5% confirmed by lab test
  • New to therapy OR continuation criteria met
  • Will NOT use in combination with a DPP-4 containing agent
  • Will NOT use in combination with another GLP-1 receptor agonist
  • Does NOT have any FDA labeled contraindications to the requested agent

Continuation of therapy

All of:

  • Requested medication is eligible for continuation of therapy
  • Will NOT use in combination with a DPP-4 containing agent
  • Will NOT use in combination with another GLP-1 receptor agonist
  • Does NOT have any FDA labeled contraindications to the requested agent

Plus any one of:

  • Documentation that the individual has been treated with the requested medication within the past 90 days
  • Prescriber states the individual has been treated with the requested medication within the past 90 days and is at risk if therapy is discontinued

Documentation to bring

  • Documentation of type 2 diabetes diagnosis (lab test result showing A1C ≥ 6.5% or other lab confirmation)
  • For continuation: documentation of treatment with requested medication within past 90 days OR prescriber attestation of recent use and risk if discontinued
  • Confirmation that DPP-4 agent will not be used concomitantly
  • Confirmation that no other GLP-1 receptor agonist will be used concomitantly
  • Confirmation of no FDA-labeled contraindications to requested agent
  • Note: Prior authorization required for members with T2DM not treated with an oral antidiabetic agent; pharmacy review required for new starts effective 04/01/2026

Approval and renewal

  • Renewal: Documentation that the individual has been treated with the requested medication within the past 90 days, OR prescriber statement that the individual has been treated within the past 90 days and is at risk if therapy is discontinued.

Not covered when

  • Concurrent use with DPP-4 containing agents (e.g., Glyxambi, Januvia, Janumet, Jentadueto, Kazano, Kombiglyze, Nesina, Onglyza, Tradjenta)
  • Concurrent use with another GLP-1 receptor agonist
  • Any FDA labeled contraindications to the requested agent
  • Samples do not count as current or stable therapy for policy requirements

Exceptions

  • State Health Plan (State and School Employees): Prescription drug benefit may be covered under a prescription drug benefit plan administered by the State Health Plan's Pharmacy Benefit Manager (CVS Caremark). Perform formulary drug search at https://www.dfa.ms.gov/cvs-caremark and submit PA requests to the Plan's PBM.
  • Structural Steel Self-Insured Group (FID# 89805): Effective 06/16/2025, all GLP-1 agonist medications are covered without Prior Authorization.
  • Glenn Machine Works Self-Insured Group (FID# 89803): Effective 12/01/2025, Wegovy and Zepbound are covered without Prior Authorization.

Policy note: Effective 04/01/2026, pharmacy review is required for new start GLP-1 prescriptions. Prior authorization is required for members with T2DM not treated with an oral antidiabetic agent. As of 04/01/2026, the prior metformin trial requirement was removed. Mounjaro is indicated for adults and pediatric patients 10 years of age and older. BCBSMS determines medication trial and adherence via pharmacy claims data over the preceding 12 months.

Policy effective April 1, 2026 · verified June 2, 2026 · source: Policy 231 · View policy document (PDF)

Open on its own page →

Questions people ask
Does BCBS Mississippi cover Mounjaro?
Yes. BCBS Mississippi covers Mounjaro for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
What does BCBS Mississippi require to renew Mounjaro?
Type 2 Diabetes — Applies to Employer plans. For continuation, ONE of the following: documentation that the individual has been treated with the requested medication within the past 90 days, OR prescriber states the individual has been treated with the requested medication within the past 90 days and is at risk if therapy is discontinued. Type 2 Diabetes — Applies to ACA Marketplace plans. Documentation that the individual has been treated with the requested medication within the past 90 days, OR prescriber statement that the individual has been treated within the past 90 days and is at risk if therapy is discontinued.
How current is this information?
The oldest review date among the policies on this page is June 2, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under BCBS Mississippi: Ozempic

Mounjaro under other plans: Mississippi Medicaid, BCBS Alabama, BCBS Arizona, BCBS Arkansas, BCBS Kansas, BCBS Louisiana, BCBS Massachusetts, BCBS Michigan

All insurance plans · All medications

Summary of BCBS Mississippi's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.