FEP Blue coverage for Mounjaro (Type 2 Diabetes)

Federal Employee Program

Covered with requirements

What you need to qualify

A1C of 6.5% or higher
Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Initial approval for Type 2 Diabetes

All of:

Diagnosis of type 2 diabetes mellitus
No dual therapy with other GLP-1 receptor agonists

Plus any one of:

HbA1c >= 6.5%
History of fasting plasma glucose (FPG) >= 126 mg/dL
History of 2-hour glucose >= 200 mg/dL during oral glucose tolerance test (OGTT)
History of symptoms of hyperglycemia (polyuria, polydipsia, polyphagia) or hyperglycemic crisis AND random plasma glucose >= 200 mg/dL

Renewal for Type 2 Diabetes

All of:

Diagnosis of type 2 diabetes mellitus
Glycemic control has improved or stabilized while on therapy
No dual therapy with other GLP-1 receptor agonists

Documentation to bring

Documentation of type 2 diabetes mellitus diagnosis
ONE of the following lab results: HbA1c >= 6.5%, fasting plasma glucose >= 126 mg/dL, 2-hour OGTT glucose >= 200 mg/dL, or random plasma glucose >= 200 mg/dL with symptoms of hyperglycemia or hyperglycemic crisis
Attestation of no concurrent use of other GLP-1 receptor agonists

Quantity limits

all strengths — 12 units per 84 days (84-day)

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for improvement in A1C and Glycemic control has improved or stabilized while on therapy. No dual therapy with other GLP-1 receptor agonists. T2DM diagnosis is re-verified at continuation.

Not covered when

Dual therapy with other GLP-1 receptor agonists
Personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
Type 1 diabetes

Policy note: Policy covers Mounjaro for type 2 diabetes only. Document explicitly states these agents are not indicated for type 1 diabetes. The prohibition on dual therapy with other GLP-1 agonists applies at both initial and renewal stages. The full list of GLP-1 agonists subject to the dual-therapy restriction is listed in Appendix 1. Rybelsus, Saxenda, Wegovy, Xultophy, Soliqua, Zepbound, Trulicity, Victoza, Byetta, Bydureon, Bydureon BCise, Adlyxin, and Ozempic are all included in that list.

Policy effective July 1, 2025 · verified June 5, 2026 · source: 5_30_086-Antidiabetic-GLP-1-GIP-Agonists.pdf