Florida Medicaid coverage for Mounjaro (Type 2 Diabetes)

What you need to qualify

• Age 10 and older
• A1C of 6.5% or higher
• Trial of metformin for at least 90 days, or a documented reason it can't be used (["intolerance", "contraindication"])
• Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Documentation to bring

• HbA1c lab result >= 6.5% within the past 6 months
• Documentation of metformin trial and failure within the past 2 years, OR documentation of contraindication or intolerance to metformin

Approval and renewal

• Initial approval: 12 months
• Renewal: every 12 months
• To renew, the plan looks for improvement in A1C and Documentation of improved clinical response (e.g., decline in HbA1c); patient has not experienced any treatment-restricting adverse effects; dosing is appropriate per labeling or supported by compendia. Initial BMI, metformin trial, and preferred agent step therapy are not re-verified at continuation.

Policy note: Mounjaro is listed as a preferred agent requiring Clinical Prior Authorization. Minimum age is 10 years (lower than Ozempic's 18 years), consistent with FDA-approved labeling for Mounjaro in pediatric patients with T2DM. The metformin trial lookback window is 2 years. A1C lookback window is 6 months. The document also covers Wegovy and Zepbound only for weight management/OSA indications, which are not addressed in this document; therefore no entries are emitted for those brands or indications. Trulicity (dulaglutide) is a preferred agent per this document but is not in the in-scope brand list, so no criteria entry is emitted. Rybelsus (oral semaglutide) and Victoza (liraglutide) are listed as non-preferred agents but are not in the in-scope brand list for separate entries.

Policy effective June 16, 2025 · verified June 4, 2026 · source: Glucagon-like%20Peptide-1%20(GLP-1)%20Receptor%20Agonist%20and%20Related%20Agents%2003.12.2026.pdf