Nevada Medicaid coverage for Mounjaro (Type 2

Medicaid

Covered with requirements

What you need to qualify

Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

T2DM glycemic control

All of:

Diagnosis of type 2 diabetes mellitus (T2DM)
Prescribed as adjunct to diet and exercise to improve glycemic control
Documentation of A1C lab results within past 180 days
No history of pancreatitis
Not prescribed for weight loss in absence of T2DM indication
Prescribed at FDA-approved dose for T2DM indication
Recipient is appropriate age per FDA label

Documentation to bring

Documentation of T2DM diagnosis
A1C lab result within past 180 days
Confirmation of no history of pancreatitis
Confirmation that medication is not being prescribed for weight loss in the absence of T2DM
Prescription at FDA-approved dose for T2DM indication

Approval and renewal

Initial approval: 12 months
Renewal: every 12 months
To renew, the plan looks for Documentation of positive response from therapy; recipient continues to meet all initial criteria.

Not covered when

History of pancreatitis
Prescribing for weight loss in absence of T2DM indication
Type 1 diabetes

Policy note: Class-level criteria (Incretin Mimetics section KK) apply to Mounjaro as a member of the incretin mimetics class. Weight loss without T2DM is explicitly excluded. Appropriate age per FDA label is required but no specific minimum/maximum age stated for the T2DM indication.

Policy effective April 6, 2026 · verified June 3, 2026 · source: msm_1200_26_04_06.pdf

Nevada Medicaid coverage for Mounjaro (Type 2 Diabetes)