California Medicaid

Does California Medicaid cover Mounjaro?

Quick answer · Type 2 Diabetes

California Medicaid covers Mounjaro for type 2 diabetes with prior authorization on Medicaid.

  • Medicaid: Covered with requirements. Diagnosis documented with a code

Last verified June 3, 2026. Policy effective April 6, 2026. Source: 12_A_GLP-1_Coverage_Considerations.pdf. How we verify this data →

Check your card for your exact plan →

Mounjaro for Type 2 Diabetes

What California Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

What you need to qualify

  • Diagnosis documented with a code

Qualification pathways

You can qualify through any one of these.

Type 2 diabetes — Code I diagnosis restriction must be met

All of:

  • Type 2 diabetes diagnosis (Code I diagnosis restriction)
  • Claim submitted with appropriate type 2 diabetes diagnosis code

Documentation to bring

  • Appropriate type 2 diabetes ICD-10-CM diagnosis code on claim (Code I diagnosis restriction)

Policy note: Mounjaro remains on the CDL with a Code I diagnosis restriction of type 2 diabetes. Claims deny with Reject Code 80 when the Code I diagnosis restriction is not met. No longer eligible for weight loss or weight loss-related indications effective January 1, 2026. PA requests for non-weight-loss indications will be reviewed for medical necessity.

Policy effective April 6, 2026 · verified June 3, 2026 · source: 12_A_GLP-1_Coverage_Considerations.pdf

Why Mounjaro requests get denied by California Medicaid

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Mounjaro and Zepbound are the same molecule with different approved uses; a request for Mounjaro under a diagnosis that matches Zepbound is routinely denied.
  2. Diagnosis code missing or wrong on the request.

Frequently asked questions

Does California Medicaid cover Mounjaro?
California Medicaid covers Mounjaro for type 2 diabetes with prior authorization on Medicaid.
How current is this information?
This page reflects California Medicaid's written policy as of April 6, 2026, last verified against the source document on June 3, 2026.

Other medications under California Medicaid

Mounjaro coverage under other plans

All insurance plans · All medications

This page summarizes California Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.