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Missouri Medicaid

Does Missouri Medicaid cover Mounjaro?

Yes. Missouri 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 3, 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.

Non-preferred agent — documented compliance to current therapy

All of:

  • Mounjaro is a non-preferred agent
  • Documented compliance to current therapy

Non-preferred agent — step therapy failure of preferred agents

All of:

  • Mounjaro is a non-preferred agent
  • Documented diagnosis of type 2 diabetes mellitus in the past year
  • Adequate therapeutic trial of metformin in the past 2 years
  • Failure to achieve desired therapeutic outcomes with trial on 3 or more preferred agents for 3 months each
  • Clinical consultant review for reason of medical necessity why Zepbound cannot be utilized

Plus any one of:

  • Documented trial period of preferred agents
  • Documented ADE/ADR to preferred agents

Documentation to bring

  • Documented diagnosis of type 2 diabetes mellitus in the past year
  • Documentation of adequate therapeutic trial of metformin in the past 2 years
  • Documentation of trial on 3 or more preferred GLP-1 agents for 3 months each with failure to achieve desired therapeutic outcomes, OR documented ADE/ADR to preferred agents
  • Clinical consultant review documentation for reason of medical necessity why Zepbound cannot be utilized
  • OR: Documentation of compliance to current therapy (alternative pathway)

Quantity limits

  • 2.5 mg/0.5 mL, 5 mg/0.5 mL, 7.5 mg/0.5 mL, 10 mg/0.5 mL, 12.5 mg/0.5 mL, 15 mg/0.5 mL — 2 mL per 28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months

Not covered when

  • Concurrent therapy with another GLP-1 receptor agonist

Policy note: Mounjaro is a non-preferred agent on the MO HealthNet PDL for diabetes. In addition to standard non-preferred agent step therapy criteria, there is an additional requirement for clinical consultant review for medical necessity documenting why Zepbound cannot be utilized. The document notes GLP-1 receptor agonists for anti-obesity are covered under a separate PDL edit; Zepbound is referenced as a comparator/alternative rather than being covered under this policy.

Policy effective January 9, 2025 · verified June 3, 2026 · source: Policy 310 · View policy document (PDF)

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Questions people ask
Does Missouri Medicaid cover Mounjaro?
Yes. Missouri 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 Missouri Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Missouri 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 Missouri Medicaid's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.