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Pennsylvania Medicaid

Does Pennsylvania Medicaid cover Mounjaro?

Yes. Pennsylvania 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 4, 2026. How we verify · Check your exact plan · Medicaid card names in Pennsylvania

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.

Non-preferred GLP-1 for diabetes — Mounjaro initial and renewal

All of:

  • Diagnosis of diabetes
  • The prescribed GLP-1 receptor agonist (Mounjaro/tirzepatide) is FDA-approved for the treatment of diabetes

Plus any one of:

  • History of therapeutic failure of the maximum FDA-approved dose of preferred GLP-1 receptor agonist(s) approved/medically accepted for the beneficiary's diagnosis
  • Contraindication to the maximum FDA-approved dose of preferred GLP-1 receptor agonist(s)
  • Intolerance to the maximum FDA-approved dose of preferred GLP-1 receptor agonist(s) (with chart documentation of troubleshooting over ≥ 1 month if switching due to intolerance)

Documentation to bring

  • Documentation of diabetes diagnosis
  • Documentation of therapeutic failure of preferred GLP-1(s) at maximum FDA-approved dose, OR contraindication or intolerance (with troubleshooting documentation over ≥ 1 month if intolerance-based: dietary changes, prescription antiemetics, dose adjustment)
  • Documentation that Mounjaro (tirzepatide) is FDA-approved for the treatment of diabetes
  • Documentation of age-appropriateness per FDA labeling, compendia, or peer-reviewed literature
  • Documentation of no contraindication to Mounjaro
  • If therapeutic duplication: documentation of intent to transition or medical reason for concomitant use

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Renewal requires: (1) diagnosis of diabetes; (2) therapeutic failure of/contraindication to/intolerance to maximum FDA-approved dose of preferred GLP-1(s) for the beneficiary's diagnosis; (3) Mounjaro is FDA-approved for diabetes. No A1C or weight thresholds re-checked at renewal.

Not covered when

  • Overweight/obesity treatment indication excluded
  • Saxenda (liraglutide) not covered for any indication

Policy note: Mounjaro is non-preferred for diabetes on the PA MA PDL. Requires therapeutic failure of, contraindication to, or intolerance to the maximum FDA-approved dose of preferred GLP-1(s) for the beneficiary's diabetes diagnosis. For intolerance-based switching (e.g., from semaglutide to tirzepatide), must document that troubleshooting was tried over at least 1 month: dietary changes (apples, crackers, mint/ginger drinks 30 minutes after dosing), prescription antiemetics, and dose adjustment if lower doses were tolerated. Approval for up to 12 months. Prescriptions limited to 1-month supply per fill.

Policy effective January 1, 2026 · verified June 4, 2026 · source: Mab2025112403 · View policy document (PDF)

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Questions people ask
Does Pennsylvania Medicaid cover Mounjaro?
Yes. Pennsylvania 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 Pennsylvania Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Pennsylvania Medicaid require to renew Mounjaro?
Type 2 Diabetes — Applies to Medicaid plans. Renewal requires: (1) diagnosis of diabetes; (2) therapeutic failure of/contraindication to/intolerance to maximum FDA-approved dose of preferred GLP-1(s) for the beneficiary's diagnosis; (3) Mounjaro is FDA-approved for diabetes. No A1C or weight thresholds re-checked at renewal.
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.

Card and program names on file in Pennsylvania

These names map to Pennsylvania Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.

Also under Pennsylvania Medicaid: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: Capital BlueCross, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, Florida Medicaid

All insurance plans · All medications

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