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New York Medicaid

Does New York Medicaid cover Mounjaro?

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

Policy on file; the document isn't available to view online yet.

  • 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.

Standard clinical criteria for GLP-1 agonist (T2DM) – Non-Preferred

All of:

  • Confirmed diagnosis of FDA-approved or compendia-supported indication that is also a Medicaid covered indication

Documentation to bring

  • Confirmation of FDA-approved or compendia-supported diagnosis that is a Medicaid covered indication
  • If concurrent GLP-1 and DPP-IV use: PA required with documentation of clinical rationale

Policy note: Mounjaro is listed as a Non-Preferred drug on the NYRx PDL under GLP-1 Receptor Agonists – Type 2 Diabetes with Clinical Criteria (CC). The same class-level clinical criteria apply: (1) confirmed diagnosis of an FDA-approved or compendia-supported indication that is also a Medicaid covered indication; (2) PA required if the patient is using a GLP-1 and DPP-IV concurrently. As a Non-Preferred agent, PA is also implicitly required to justify non-preferred use over preferred alternatives (e.g., Ozempic, exenatide, Trulicity). The document does not provide additional quantitative non-preferred step-therapy criteria beyond the class CC. A standardized PA fax form is available at https://newyork.fhsc.com/downloads/providers/NYRx PDP PA Fax Standardized.pdf. The document lists this section as revised April 23, 2026; Mounjaro was noted as Non-Preferred as of 2/19/2026.

Policy effective April 23, 2026 · verified June 3, 2026 · source: Nyrx Pdp Pdl

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Questions people ask
Does New York Medicaid cover Mounjaro?
Yes. New York Medicaid covers Mounjaro for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
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 New York Medicaid: Ozempic, Wegovy

Mounjaro under other plans: Elevance Health, Excellus BCBS, Molina Healthcare, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid

All insurance plans · All medications

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