Missouri Medicaid coverage for Mounjaro (Type 2 Diabetes)

What you need to qualify

• Diagnosis documented with a code
• Trial of metformin for at least 730 days, or a documented reason it can't be used
• Prior trial of 3 other GLP-1 medications (preferred GLP-1 receptor agonists (Ozempic, Trulicity, Victoza)) for at least 90 days

Qualification pathways

You can qualify through any one of these.

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.html