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Elevance Health

Does Elevance Health cover Mounjaro?

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

Policy document

  • Employer: Covered (preferred drug). 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 Employer plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Standard T2DM with metformin failure or contraindication

All of:

  • Age ≥ 10 years
  • Diagnosis of type 2 diabetes
  • Lab-verified diagnosis: A1C ≥ 6.5% OR FPG ≥ 126 mg/dL OR 2-hr plasma glucose ≥ 200 mg/dL on OGTT OR symptoms of hyperglycemia/crisis with random glucose ≥ 200 mg/dL

Plus any one of:

  • Trial and inadequate response or intolerance to metformin (samples/coupons/discount cards excluded)
  • Contraindication to metformin therapy

Documentation to bring

  • Documentation of type 2 diabetes diagnosis
  • Lab result confirming diagnosis: A1C ≥ 6.5%, OR fasting plasma glucose ≥ 126 mg/dL (after fasting ≥ 8 hours), OR 2-hour plasma glucose ≥ 200 mg/dL on 75g OGTT, OR random plasma glucose ≥ 200 mg/dL with symptoms of hyperglycemia/crisis
  • Documentation of metformin trial with inadequate response or intolerance (samples/coupons/discount cards not accepted), OR documentation of metformin contraindication

Quantity limits

  • all available strengths — 4 single dose pens/single dose vials per 28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: At continuation, T2DM diagnosis and lab verification are re-verified. Metformin trial/contraindication requirement is NOT re-checked at continuation.

Not covered when

  • Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • Personal or family history of medullary thyroid carcinoma (MTC)
  • Severe gastroparesis
  • Prediabetes
  • Obesity/weight loss indication
  • Concomitant use with another GLP-1 receptor agonist (including Saxenda, Wegovy, Zepbound, Soliqua, or Xultophy)
  • Concomitant use with a DPP-4 inhibitor
  • Type 1 diabetes

Policy note: Mounjaro is listed as a preferred GIP/GLP-1 receptor agonist. Age minimum is 10 years. The ASCVD bypass to metformin step therapy is NOT listed for Mounjaro (unlike liraglutide-generic, Ozempic, Rybelsus, and Trulicity which have this bypass). Non-preferred agents require two preferred agent failures before approval.

Policy effective May 5, 2026 · verified June 2, 2026 · source: Elevance Health Employer / Commercial Insurance prior authorization policy · View policy document (PDF)

Open on its own page →

Questions people ask
Does Elevance Health cover Mounjaro?
Yes. Elevance Health 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 Elevance Health?
Type 2 Diabetes — Applies to Employer plans. Initial approval: 12 months. Renewal: every 12 months.
What does Elevance Health require to renew Mounjaro?
Type 2 Diabetes — Applies to Employer plans. At continuation, T2DM diagnosis and lab verification are re-verified. Metformin trial/contraindication requirement is NOT re-checked at continuation.
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 Elevance Health: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: California Medicaid, Colorado Medicaid, Connecticut Medicaid, Excellus BCBS, Georgia Medicaid, Indiana Medicaid, Kaiser Permanente Mid-Atlantic, Kaiser Permanente Northern California

All insurance plans · All medications

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