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
ACA Marketplace
Covered with requirements
What you need to qualify
Diagnosis documented with a code
Lab results confirming eligibility
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
To renew, the plan looks for 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
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
