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North Dakota Medicaid

Does North Dakota Medicaid cover Mounjaro for Type 2 Diabetes?

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

Policy document

  • 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.

Pathway A: Diabetes with prior GLP-1 failure

All of:

  • Member has been unable to achieve goal A1C (≤7%) or TIR (>70%) despite a 90-day trial of triple combination therapy consisting of Ozempic (liraglutide, Rybelsus, and Trulicity must be trialed if Ozempic is not tolerated), along with metformin, SGLT-2 inhibitor or insulin, as evidenced by paid claims or pharmacy printouts
  • If triple therapy cannot be met with liraglutide/Ozempic/Rybelsus/Trulicity, clinical justification must be provided and triple therapy must be met with SGLT-2 inhibitor + DPP4 inhibitor + metformin

Plus any one of:

  • Requested medication prescribed by or in consult with an endocrinologist or diabetes specialist
  • Member has received diabetes education from a diabetic specialist, diabetic educator, or pharmacist (may be accomplished through the MTM program)

Pathway B: Member qualifies for tirzepatide based on Sleep Apnea criteria

All of:

  • Member is otherwise eligible for approval for tirzepatide based on the Sleep Apnea (OSA) criteria (see Zepbound OSA entry)
  • If member qualifies for tirzepatide, the most cost-effective tirzepatide product will be authorized

Documentation to bring

  • Evidence of inability to achieve goal A1C (≤7%) or TIR (>70%) despite 90-day trial of triple combination therapy (Ozempic/liraglutide/Rybelsus/Trulicity + metformin + SGLT-2 inhibitor or insulin), evidenced by paid claims or pharmacy printouts
  • Prescriber attestation of consultation with endocrinologist or diabetes specialist, OR documentation of diabetes education from diabetic specialist, educator, or pharmacist
  • If GI intolerance bypasses GLP-1 trial: chart documentation showing dietary changes, meal size reduction, prescription antiemetics, and dose adjustment were trialed for at least two months

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Member must have experienced and maintained clinical benefit; must be at least 80% adherent.

Not covered when

  • DPP-4 inhibitors and GLP-1 agonists not payable together
  • Note: if member qualifies for tirzepatide, the most cost-effective tirzepatide product will be authorized (Mounjaro vs Zepbound)

Policy note: Mounjaro (tirzepatide) is a NON-PREFERRED GIP/GLP-1 agonist requiring PA. PA required. Step therapy requires trial of Ozempic-based triple therapy first (or liraglutide/Rybelsus/Trulicity if Ozempic not tolerated). Alternatively, member may qualify via the OSA tirzepatide pathway. The document states: 'If the member qualifies for tirzepatide, the most cost-effective tirzepatide product will be authorized' - meaning Mounjaro and Zepbound are interchangeable cost-effectively. GI intolerances (high dose IR metformin: must trial minimum 500mg ER; for GLP-1 GI effects: must document dietary changes, meal reduction, antiemetics, and dose adjustment for at least 2 months before bypassing trial requirement).

Policy effective April 1, 2026 · verified June 3, 2026 · source: Pdl 2026.4 · View policy document (PDF)

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Questions people ask
Does North Dakota Medicaid cover Mounjaro?
Yes. North Dakota Medicaid covers Mounjaro for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Mounjaro approval last with North Dakota Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does North Dakota Medicaid require to renew Mounjaro?
Type 2 Diabetes — Applies to Medicaid plans. Member must have experienced and maintained clinical benefit; must be at least 80% adherent.
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 North Dakota Medicaid: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: BCBS North Dakota, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, Florida Medicaid

All insurance plans · All medications

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