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PacificSource Health

Does PacificSource Health cover Mounjaro for Type 2 Diabetes?

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

Policy document

  • Employer and ACA Marketplace: Covered with requirements. See the qualification pathways below.

Earliest policy review June 10, 2026. How we verify · Check your exact plan

Full requirements: Mounjaro for Type 2 Diabetes (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Type 2 Diabetes

All of:

  • Diagnosis of Type 2 diabetes confirmed with lab testing
  • No concurrent use of other GLP-1 receptor agonists
  • Not using for weight loss or other excluded diagnosis
  • Not in diabetes remission (HbA1c < 6.5% for at least 3 months without glucose-lowering therapy)

Documentation to bring

  • Lab confirmation of Type 2 diabetes diagnosis
  • Claims history and ICD-10 codes reviewed
  • Documentation that patient is not using concurrently with another GLP-1 receptor agonist

Approval and renewal

  • Initial approval: 24 months
  • Renewal: every 24 months
  • Renewal: Documentation of disease responsiveness to therapy required at reauthorization.

Not covered when

  • Use for weight loss or other excluded diagnosis
  • Dosing above FDA-approved label for treatment of diabetes
  • Diabetes remission (HbA1c < 6.5% persisting ≥3 months without usual glucose-lowering therapy)
  • History of ketoacidosis
  • Concurrent use of other GLP-1 receptor agonists

Policy note: Mounjaro is FDA-approved for T2DM. Policy covers all FDA-approved indications not otherwise excluded. Authorization duration is 24 months unless otherwise specified.

Policy effective June 22, 2026 · verified June 10, 2026 · source: Cw577pv8jf · View policy document (PDF)

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Questions people ask
Does PacificSource Health cover Mounjaro?
Yes. PacificSource Health 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 PacificSource Health?
Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Initial approval: 24 months. Renewal: every 24 months.
What does PacificSource Health require to renew Mounjaro?
Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Documentation of disease responsiveness to therapy required at reauthorization.
How current is this information?
The oldest review date among the policies on this page is June 10, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under PacificSource Health: Ozempic, Wegovy

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

All insurance plans · All medications

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