Skip to content

BCBS Tennessee

Does BCBS Tennessee cover Mounjaro for Type 2 Diabetes?

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

Policy document

  • Medicare Advantage: Covered with requirements. 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 (1 plan type)

Applies to Medicare Advantage plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Ongoing T2DM treatment with chart note confirmation

All of:

  • Medical records (e.g., chart notes) confirming diagnosis of T2DM for ongoing treatment

T2DM diagnosis confirmed by laboratory values

All of:

  • Medical records (e.g., chart notes) confirming diagnosis of T2DM

Plus any one of:

  • A1C ≥ 6.5%
  • 2-hour plasma glucose ≥ 200 mg/dL during OGTT
  • Symptoms of hyperglycemia or hyperglycemic crisis AND random plasma glucose ≥ 200 mg/dL
  • Fasting plasma glucose ≥ 126 mg/dL (fasted at least 8 hours)

Documentation to bring

  • Medical records (e.g., chart notes) confirming diagnosis of T2DM
  • If lab confirmation pathway: lab result showing A1C ≥ 6.5%, OR 2-hour PG ≥ 200 mg/dL during OGTT, OR random plasma glucose ≥ 200 mg/dL with hyperglycemia symptoms, OR fasting plasma glucose ≥ 126 mg/dL
  • Confirmation that patient has no FDA-labeled contraindications to the requested agent
  • Confirmation that patient will not use the agent in combination with another GLP-1 agonist or GLP-1-containing agent
  • Confirmation that patient will not use the agent in combination with a DPP-4 inhibitor

Quantity limits

  • all strengths — 30-day supply

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months

Not covered when

  • Concurrent use with another GLP-1 agonist or GLP-1-containing agent
  • Concurrent use with a DPP-4 inhibitor
  • Use for weight loss only

Policy note: Coverage duration is plan year with 30-day supply per dispensing. Excluded when used for weight loss only. Two pathways to qualify: (1) ongoing T2DM treatment confirmed by chart notes, or (2) new T2DM diagnosis confirmed by chart notes plus qualifying lab value.

Policy effective June 1, 2026 · verified June 2, 2026 · source: 2026 Partd Prior Authorization Criteria Ma · View policy document (PDF)

Open on its own page →

Questions people ask
Does BCBS Tennessee cover Mounjaro?
Yes. BCBS Tennessee covers Mounjaro for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Mounjaro approval last with BCBS Tennessee?
Type 2 Diabetes — Applies to Medicare Advantage plans. Initial approval: 12 months. Renewal: every 12 months.
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 Tennessee: Ozempic

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

All insurance plans · All medications

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