Kaiser Permanente Northwest

Does Kaiser Permanente Northwest cover Mounjaro?

Quick answer · Type 2 Diabetes

Kaiser Permanente Northwest covers Mounjaro for type 2 diabetes with prior authorization on Employer / Commercial Insurance.

  • Employer / Commercial Insurance: Covered with requirements. Diagnosis documented with a code (E08, E09, E11, E13)

Last verified June 5, 2026. Policy effective March 9, 2026. Source: mi-all-pa-guidelines-nw-en.pdf. How we verify this data →

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Mounjaro for Type 2 Diabetes

What Kaiser Permanente Northwest requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Diagnosis documented with a code (E08, E09, E11, E13)

Qualification pathways

You can qualify through any one of these.

Type 2 Diabetes Approval

All of:

  • Diagnosis of type 2 diabetes (ICD-10 Groups E08, E09, E13, or E11 except E11.A)
  • Diagnosis confirmed by medical records OR chart notes

Documentation to bring

  • Medical records or chart notes confirming type 2 diabetes diagnosis (ICD-10 Groups E08, E09, E13, or E11 except E11.A)

Approval and renewal

  • Initial approval: 12 months

Not covered when

  • ICD-10 code E11.A is explicitly excluded from qualifying T2DM diagnosis codes

Policy note: Approved for all strengths by GPID or GPI-14. ICD-10 code E11.A is explicitly excluded from the qualifying diagnosis codes despite being within the E11 group. Document does not address weight loss, CV risk reduction, or any other indication for Mounjaro.

Policy effective March 9, 2026 · verified June 5, 2026 · source: mi-all-pa-guidelines-nw-en.pdf

Why Mounjaro requests get denied by Kaiser Permanente Northwest

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 Kaiser Permanente Northwest cover Mounjaro?
Kaiser Permanente Northwest covers Mounjaro for type 2 diabetes with prior authorization on Employer / Commercial Insurance.
How long does a Mounjaro approval last with Kaiser Permanente Northwest?
Initial approvals last 12 months.
How current is this information?
This page reflects Kaiser Permanente Northwest's written policy as of March 9, 2026, last verified against the source document on June 5, 2026.

Other medications under Kaiser Permanente Northwest

Mounjaro coverage under other plans

All insurance plans · All medications

This page summarizes Kaiser Permanente Northwest'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.