New York Medicaid

Does New York Medicaid cover Mounjaro?

Quick answer · Type 2 Diabetes

New York Medicaid covers Mounjaro for type 2 diabetes with prior authorization on Medicaid.

  • Medicaid: Covered with requirements. No additional clinical requirements listed.

Last verified June 3, 2026. Policy effective April 23, 2026. Source: nyrx_pdp_pdl.pdf. How we verify this data →

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Mounjaro for Type 2 Diabetes

What New York Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered with requirements

No additional clinical requirements are listed beyond the diagnosis.

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.pdf

Why Mounjaro requests get denied by New York Medicaid

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Mounjaro and Zepbound are the same molecule with different approved uses; a request for Mounjaro under a diagnosis that matches Zepbound is routinely denied.

Frequently asked questions

Does New York Medicaid cover Mounjaro?
New York Medicaid covers Mounjaro for type 2 diabetes with prior authorization on Medicaid.
How current is this information?
This page reflects New York Medicaid's written policy as of April 23, 2026, last verified against the source document on June 3, 2026.

Other medications under New York Medicaid

Mounjaro coverage under other plans

All insurance plans · All medications

This page summarizes New York Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.