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Kentucky Medicaid

Does Kentucky Medicaid cover Mounjaro?

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

Policy document

  • Medicaid: Covered (preferred drug). See the qualification pathways below.

Earliest policy review July 7, 2026. How we verify · Check your exact plan

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

Applies to Medicaid plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial approval for Type 2 Diabetes

All of:

  • ICD-10 diagnosis of T2DM confirmed in chart notes within the past 12 months
  • A1C lab value ≥ 6.5% (current within past 6 months, OR historical ≥ 6.5% PLUS current A1C within past 6 months)
  • No personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • Not used in combination with another GLP-1 receptor agonist OR DPP-4 inhibitor (unless member is changing therapy)
  • Requested dose does not exceed maximum FDA-approved dose for treatment of diabetes mellitus

Documentation to bring

  • ICD-10 diagnosis of T2DM in chart notes within the past 12 months
  • A1C lab value ≥ 6.5% (current within past 6 months; OR historical ≥ 6.5% PLUS current A1C within past 6 months)
  • Attestation of no personal or family history of MTC or MEN 2
  • Attestation that drug will not be combined with another GLP-1 or DPP-4 inhibitor (unless changing therapy)

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 6 months
  • Renewal: Improvement in A1C.
  • Renewal: At renewal: ICD-10 diagnosis of T2DM (chart notes within past 12 months); A1C value within past 6 months; provider attestation of positive response to therapy (safety and efficacy); no personal/family history of MTC or MEN 2; not used in combination with another GLP-1 or DPP-4 (unless changing therapy); dose does not exceed maximum FDA-approved dose for diabetes.

Not covered when

  • Drugs used for anorexia, weight loss, or weight gain are excluded from coverage under this benefit (per policy footnote: '*Drugs used for anorexia, weight loss, or weight gain are excluded from coverage.')

Policy note: Mounjaro is a Preferred agent (Preferred with PA). Non-preferred GLP-1s require ≥ 3-month trial and failure, allergy, contraindication, or intolerance of 2 preferred agents. GLP-1 medications are limited to two brand switches per year. The footnote '*Drugs used for anorexia, weight loss, or weight gain are excluded from coverage' appears in the GLP-1 section and applies to use of these agents for weight loss/anorexia purposes; coverage is limited to the T2DM indication.

Policy effective July 1, 2026 · verified July 7, 2026 · source: Kentucky Medicaid PA Criteria · View policy document (PDF)

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Questions people ask
Does Kentucky Medicaid cover Mounjaro?
Yes. Kentucky 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 Kentucky Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 6 months.
What does Kentucky Medicaid require to renew Mounjaro?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. At renewal: ICD-10 diagnosis of T2DM (chart notes within past 12 months); A1C value within past 6 months; provider attestation of positive response to therapy (safety and efficacy); no personal/family history of MTC or MEN 2; not used in combination with another GLP-1 or DPP-4 (unless changing therapy); dose does not exceed maximum FDA-approved dose for diabetes.
How current is this information?
The oldest review date among the policies on this page is July 7, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Kentucky Medicaid: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: Elevance Health, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, Florida Medicaid

All insurance plans · All medications

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