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Oregon Medicaid

Does Oregon Medicaid cover Mounjaro for Type 2 Diabetes?

Yes. Oregon 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 4, 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.

T2DM with metformin failure or contraindication

All of:

  • Diagnosis of Type 2 diabetes mellitus
  • Prescriber will not switch to a preferred product OR preferred product has been considered

Plus any one of:

  • Tried and failed to meet hemoglobin A1C goals with metformin
  • Contraindication to metformin

Documentation to bring

  • ICD-10 diagnosis code for Type 2 diabetes mellitus
  • Documentation of metformin trial and failure to meet A1C goals, OR documentation of metformin contraindication
  • Documentation that prescriber considered switching to a preferred product

Approval and renewal

  • Initial approval: 12 months

Not covered when

  • Type 1 diabetes

Policy note: Mounjaro is covered under the class-level GLP-1/GIP receptor agonist PA criteria. Same criteria as GLP-1 agonists for T2DM. The policy title explicitly includes GIP receptor agonists alongside GLP-1 receptor agonists. Non-preferred products require PA. For weight loss indication, the policy references a separate weight management PA criteria document. Metformin titration schedule is provided. The document does not specify a minimum metformin trial duration in days.

Policy effective March 1, 2026 · verified June 4, 2026 · source: Oregon%20 Medicaid%20 PA%20 Criteria%20 Guide%20 %20 June%201%2 C%202026

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Questions people ask
Does Oregon Medicaid cover Mounjaro?
Yes. Oregon 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 Oregon Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 12 months.
How current is this information?
The oldest review date among the policies on this page is June 4, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Oregon Medicaid: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: Kaiser Permanente Northwest, PacificSource Health, Regence, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid

All insurance plans · All medications

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