Connecticut Medicaid coverage for Mounjaro (Type 2

Medicaid

Covered with requirements

What you need to qualify

Age 10 and older
A1C of 6.5% or higher
Diagnosis documented with a code
Prior trial of another GLP-1 medication (Byetta, Ozempic injection, Trulicity, and Victoza)
Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Initial approval — non-preferred agent for T2DM

All of:

Documented diagnosis of type 2 diabetes mellitus confirmed by: A1c ≥6.5%, OR fasting plasma glucose ≥126 mg/dL, OR 2-hour plasma glucose ≥200 mg/dL during OGTT, OR classic hyperglycemia symptoms with random plasma glucose ≥200 mg/dL
Trial and failure of at least one preferred agent (Byetta, Ozempic injection, Trulicity, or Victoza) demonstrated by failure to improve/maintain glycemic control (lab values after initiation required) OR documented adverse drug reaction/event or contraindication to ALL four preferred agents (GI side effects alone do not qualify unless prescriber provides medical justification)
Provider attests GLP-1 receptor agonist will be used alongside diet and exercise
Prescribed medication will not be used with another GLP-1 receptor agonist
Patient does not have personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2)
Patient is not on concomitant DPP-4 inhibitor therapy OR provider attests patient is transitioning from a DPP-4 inhibitor to a GLP-1 receptor agonist

Documentation to bring

Appropriate diagnosis code on prescription
Chart note or laboratory results documenting T2DM diagnosis (A1c ≥6.5%, fasting glucose ≥126 mg/dL, 2-hour OGTT glucose ≥200 mg/dL, or classic hyperglycemia symptoms with random glucose ≥200 mg/dL)
Laboratory values dated after initiation of preferred agent documenting insufficient glycemic response OR documentation of adverse drug reaction/event or contraindication to Byetta, Ozempic injection, Trulicity, and Victoza (medical justification required if GI side effects cited as intolerance)
Provider attestation that GLP-1 will be used alongside diet and exercise
Provider attestation that prescribed medication will not be used with another GLP-1 receptor agonist
For continuation: baseline AND recent (within 180 days of submission) A1c/glycemic lab values with dates

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for improvement in A1C and Documented improvement in hemoglobin A1c; submission of baseline AND recent (within 180 days) lab values with dates documenting improvement in glycemic control or maintenance of glycemic goal required. Patient must not be on concomitant DPP-4 inhibitor therapy. T2DM diagnosis must still be documented.

Not covered when

Personal or family history of medullary thyroid carcinoma (MTC)
Personal or family history of multiple endocrine neoplasia syndrome type 2 (MEN 2)
Concomitant use of another GLP-1 receptor agonist containing product
Concomitant DPP-4 inhibitor use (unless transitioning)

Policy note: Mounjaro is listed as a non-preferred agent. Preferred agents are Byetta, Ozempic (injection), Trulicity, and Victoza. Minimum age is 10 years (updated in V2 revision dated 12/30/2025; prior to that age limit was not specified for Mounjaro). Gastrointestinal side effects from preferred agents are not considered intolerance unless prescriber provides medical justification for discontinuation. Use of samples to initiate therapy does not meet step therapy requirements. Prior therapies verified through pharmacy claims and/or chart notes. For brand requests when generic is preferred, or vice versa, provider must document medical reason. The document is prepared for CT (Connecticut) and implemented by Gainwell Technologies.

Policy effective January 1, 2026 · verified June 3, 2026 · source: GLP-1.pdf

Connecticut Medicaid coverage for Mounjaro (Type 2 Diabetes)