Idaho Medicaid

Does Idaho Medicaid cover Mounjaro?

Quick answer · Type 2 Diabetes

Idaho Medicaid covers Mounjaro for type 2 diabetes with prior authorization on Medicaid.

  • Medicaid: Covered with requirements. Diagnosis documented with a code (E11)

Last verified June 4, 2026. Policy effective January 1, 2026. Source: policy-396.html. How we verify this data →

Check your card for your exact plan →

Mounjaro for Type 2 Diabetes

What Idaho 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 (E11)

Qualification pathways

You can qualify through any one of these.

Non-preferred agent — T2DM diagnosis

All of:

  • ICD-10 diagnosis of type 2 diabetes mellitus in member's record or submitted with pharmacy claim

Documentation to bring

  • ICD-10 diagnosis code for type 2 diabetes mellitus in member's record or submitted with pharmacy claim

Policy note: Mounjaro (tirzepatide) is listed as a Non-Preferred Agent under the GLP-1 Receptor Agonists class. The document states criteria apply to preferred agents; the only criterion listed is an ICD-10 type 2 diabetes diagnosis. Non-preferred agents typically require PA on a Medicaid PDL; the document does not specify additional non-preferred criteria beyond the class-level T2DM diagnosis requirement. Rybelsus (semaglutide oral) is also listed as a Non-Preferred Agent and shares the same class criteria. Trulicity, Victoza, Bydureon BCISE, Byetta, and liraglutide also appear but are out of scope.

Policy effective January 1, 2026 · verified June 4, 2026 · source: policy-396.html

Why Mounjaro requests get denied by Idaho Medicaid

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

  1. 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.
  2. Diagnosis code missing or wrong on the request.

Frequently asked questions

Does Idaho Medicaid cover Mounjaro?
Idaho Medicaid covers Mounjaro for type 2 diabetes with prior authorization on Medicaid.
How current is this information?
This page reflects Idaho Medicaid's written policy as of January 1, 2026, last verified against the source document on June 4, 2026.

Other medications under Idaho Medicaid

Mounjaro coverage under other plans

All insurance plans · All medications

This page summarizes Idaho Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.