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Premera

Does Premera cover Mounjaro for Type 2 Diabetes?

Yes. Premera 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 (preferred drug). 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 (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial approval for Type 2 Diabetes (First-Line, adults and pediatric)

All of:

  • Individual is aged 10 years or older
  • Diagnosed with type 2 diabetes
  • Has had an adequate trial of or a contraindication to metformin
  • Drug will not be used in combination with another GLP-1 or GIP/GLP-1 receptor agonist
  • Does not exceed FDA labeled maximum daily dose

Documentation to bring

  • Office visit notes containing the diagnosis of type 2 diabetes
  • Relevant history and physical evaluation
  • Medication history documenting adequate trial of or contraindication to metformin
  • Documentation that drug will not be used in combination with another GLP-1 or GIP/GLP-1 receptor agonist

Quantity limits

  • 2.5 mg/0.5 mL — 4 pens (2 mL)
  • 5 mg/0.5 mL — 4 pens (2 mL)
  • 7.5 mg/0.5 mL — 4 pens (2 mL)
  • 10 mg/0.5 mL — 4 pens (2 mL)
  • 12.5 mg/0.5 mL — 4 pens (2 mL)
  • 15 mg/0.5 mL — 4 pens (2 mL)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Re-authorization approved up to 12 months as long as drug-specific coverage criteria are met and chart notes demonstrate the individual continues to show a positive clinical response to therapy.

Not covered when

  • Use in combination with another GLP-1 or GIP/GLP-1 receptor agonist is excluded
  • Exceeding FDA labeled maximum daily dose is excluded

Policy note: Mounjaro is listed as a first-line preferred GIP/GLP-1 receptor agonist for type 2 diabetes in adults and pediatric individuals aged 10 and older. The policy states that 'adequate trial of or a contraindication to metformin' is required but does not specify a duration for the metformin trial. Mounjaro is also listed as one of the qualifying step-therapy drugs that must be tried before Victoza (liraglutide) can be approved, but Mounjaro itself does not require prior GLP-1 trial. Diagnosis of type 2 diabetes must meet criteria defined in the Related Information section.

Policy effective May 1, 2026 · verified June 3, 2026 · source: 5.01.569 · View policy document (PDF)

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Questions people ask
Does Premera cover Mounjaro?
Yes. Premera 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 Premera?
Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does Premera require to renew Mounjaro?
Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Re-authorization approved up to 12 months as long as drug-specific coverage criteria are met and chart notes demonstrate the individual continues to show a positive clinical response to therapy.
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 Premera: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: Kaiser Permanente Northwest, Molina Healthcare, Regence, Washington Medicaid, Elevance Health, HCSC, Wellmark, Aetna

All insurance plans · All medications

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