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Kansas Medicaid

Does Kansas Medicaid cover Mounjaro for Type 2 Diabetes?

Yes. Kansas Medicaid covers Mounjaro for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan

Full requirements: Mounjaro for Type 2 Diabetes (1 plan type)

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Glycemic control in T2DM

All of:

  • Diagnosis of T2DM
  • Age ≥ 18 years
  • Prescriber provides prespecified HbA1c goal of 6.5%, 7.0%, or 8.0%
  • Baseline HbA1c obtained within past 6 months that is greater than the prespecified goal
  • Dose does not exceed 15 mg SQ weekly
  • Patient is not currently on a DPP-4 inhibitor
  • Preferred PDL drug trial completed unless non-preferred PDL PA criteria met

Plus any one of:

  • Adequate trial of generic metformin IR or metformin ER for at least 90 consecutive days in the past 120-day period
  • Prescribed generic metformin IR or ER concurrently with requested drug AND HbA1c ≥ 1.5% above prespecified goal
  • Contraindication to metformin

Documentation to bring

  • Prescriber-specified HbA1c goal (6.5%, 7.0%, or 8.0%)
  • Baseline HbA1c lab result obtained within the past 6 months showing value greater than the prespecified goal
  • Documentation of metformin trial (≥90 consecutive days in past 120 days), concurrent metformin prescription with HbA1c ≥1.5% above goal, or contraindication to metformin
  • Confirmation patient is not currently on a DPP-4 inhibitor
  • Documentation that preferred PDL drug was tried or reason for non-preferred PA criteria

Quantity limits

  • 2.5mg, 5mg, 7.5mg, 10mg, 12.5mg, 15mg — Max 15 mg SQ once weekly

Approval and renewal

  • Initial approval: 6 months
  • Renewal: Improvement in A1C.
  • Renewal: Renewal requires either: (1) reduction of HbA1c of at least 1% since the last approval, OR (2) achievement or maintenance of therapeutic HbA1c goal as specified on the initial request. Renewal duration is 12 months if at HbA1c goal, or 6 months if not at goal but at least 1% further reduction. Age and dosing limits must still be met.

Not covered when

  • Concurrent DPP-4 inhibitor use
  • Type 1 diabetes

Policy note: Mounjaro (tirzepatide) is classified as a GIP/GLP-1 receptor agonist in Table 1. It is listed only for glycemic control in T2DM in this policy; no CV, CKD, weight loss, or OSA indications are listed. Zepbound (tirzepatide for weight loss/OSA) is NOT mentioned in this document. The policy is specific to Type 2 Diabetes Mellitus agents only.

Policy effective April 16, 2025 · verified June 4, 2026 · source: Diabetes Mellitus Type 2 Agents Pdf · View policy document (PDF)

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Questions people ask
Does Kansas Medicaid cover Mounjaro?
Yes. Kansas Medicaid covers Mounjaro for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Mounjaro approval last with Kansas Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 6 months.
What does Kansas Medicaid require to renew Mounjaro?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. Renewal requires either: (1) reduction of HbA1c of at least 1% since the last approval, OR (2) achievement or maintenance of therapeutic HbA1c goal as specified on the initial request. Renewal duration is 12 months if at HbA1c goal, or 6 months if not at goal but at least 1% further reduction. Age and dosing limits must still be met.
How current is this information?
The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Kansas Medicaid: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: BCBS Kansas, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, Florida Medicaid

All insurance plans · All medications

Summary of Kansas Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.