New Hampshire Medicaid coverage for Mounjaro (Type

Medicaid

Covered with requirements

What you need to qualify

Age 18 and older

Qualification pathways

You can qualify through any one of these.

Initial approval for T2DM

All of:

Diagnosis of type 2 diabetes mellitus
Patient age supported by FDA-approved indication (adults)
Medication used as adjunct to diet and exercise
Trial of an oral antihyperglycemic

Documentation to bring

Documentation of type 2 diabetes mellitus diagnosis
Documentation of patient age consistent with FDA-approved indication
Documentation of prior trial of an oral antihyperglycemic agent

Approval and renewal

Initial approval: 12 months

Not covered when

Type 1 diabetes

Policy note: Non-preferred drugs on the Preferred Drug List (PDL) require additional prior authorization. Mounjaro is listed only for T2DM glycemic control (adults); no weight loss indication is addressed in this document. The approval criteria apply uniformly to all listed GLP-1 agonists.

Policy effective June 5, 2025 · verified June 4, 2026 · source: 9105e0b5-0a2e-48dc-d176-594ab9907de5

New Hampshire Medicaid coverage for Mounjaro (Type 2 Diabetes)