Kaiser Permanente Northwest coverage for Mounjaro (Type 2 Diabetes)

What you need to qualify

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

Qualification pathways

You can qualify through any one of these.

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