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California Medicaid

Does California Medicaid cover Mounjaro?

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

Policy document

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Mounjaro for Type 2 Diabetes (1 plan type)

Applies to Medicaid plans.

Covered with requirements

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 · View policy document (PDF)

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Questions people ask
Does California Medicaid cover Mounjaro?
Yes. California Medicaid covers Mounjaro for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under California Medicaid: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: Elevance Health, Kaiser Permanente Northern California, Kaiser Permanente Southern California, Molina Healthcare, Alabama Medicaid, Arkansas Medicaid, Colorado Medicaid, Connecticut Medicaid

All insurance plans · All medications

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