How long does a Mounjaro approval last with Delaware Medicaid?

Initial approvals last 6 months.

What does Delaware Medicaid require to renew Mounjaro?

Provider must document reason for dose change (titrating) or no dose change (maintenance). Change in dose: approval up to 1 month in <=30-day supplies. No change in dose: approval up to 6 months in <=90-day supplies.

How current is this information?

This page reflects Delaware Medicaid's written policy as of April 20, 2026, last verified against the source document on June 4, 2026.

Does Delaware Medicaid cover Mounjaro?

Mounjaro for Type 2 Diabetes

What Delaware 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.

Initial approval for T2DM

All of:

Diagnosis of type 2 diabetes mellitus (T2DM) with ICD-10 code provided
FDA-approved indication for the requested GLP-1 agonist
Dosage, frequency, and age within FDA-approved range
No contraindicated conditions or diseases with GLP-1 agonist therapy
Member is not currently on another GLP-1 agonist

Non-preferred agent request

All of:

All initial approval criteria met
Preferred GLP-1 agents have been tried and results documented in medical records

Documentation to bring

Member's relevant medical records and/or pharmacy profile
Appropriate baseline diagnostic and safety laboratory and/or noninvasive test results
ICD-10 diagnosis code for T2DM
Pharmacy claims history or pharmacy profile
Documentation that dosage, frequency, and age are within FDA-approved range
Documentation that member has no contraindicated conditions/diseases with GLP-1 agonist therapy
Documentation that member is not currently on another GLP-1 agonist
If brand name is medically necessary: MedWatch Form 3500
If non-preferred agent: documentation that preferred medications have been utilized with results

Quantity limits

all strengths — ≤30-day supply (initial and dose-change re-authorization); ≤90-day supply (re-authorization with no dose change) (84-day)

Approval and renewal

Initial approval: 6 months
To renew, the plan looks for Provider must document reason for dose change (titrating) or no dose change (maintenance). Change in dose: approval up to 1 month in <=30-day supplies. No change in dose: approval up to 6 months in <=90-day supplies.

Not covered when

Contraindicated conditions or diseases with GLP-1 agonist therapy
Currently on another GLP-1 agonist
Off-label/unapproved indications without two peer-reviewed articles demonstrating safety and efficacy

Policy note: This is a Delaware Medicaid (DMAP) PA request form for GLP-1 agonists for T2DM. The policy is class-level (all GLP-1 agonists for T2DM) and does not specify individual brand criteria. Mounjaro is included as an in-scope GLP-1 agonist FDA-approved for T2DM. Initial authorization is for a 6-month trial dispensed in ≤30-day supplies. Re-authorization: dose change = up to 1 month in ≤30-day supplies; no dose change = up to 6 months in ≤90-day supplies. Preferred vs. non-preferred distinction exists but specific preferred agents are not listed in this document. Brand name medical necessity requires MedWatch Form 3500.

Policy effective April 20, 2026 · verified June 4, 2026 · source: Pa policy

Why Mounjaro requests get denied by Delaware Medicaid

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

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.
Diagnosis code missing or wrong on the request.

Frequently asked questions

Does Delaware Medicaid cover Mounjaro?: Delaware Medicaid covers Mounjaro for type 2 diabetes with prior authorization on Medicaid.
How long does a Mounjaro approval last with Delaware Medicaid?: Initial approvals last 6 months.
What does Delaware Medicaid require to renew Mounjaro?: Provider must document reason for dose change (titrating) or no dose change (maintenance). Change in dose: approval up to 1 month in <=30-day supplies. No change in dose: approval up to 6 months in <=90-day supplies.
How current is this information?: This page reflects Delaware Medicaid's written policy as of April 20, 2026, last verified against the source document on June 4, 2026.