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Does Priority Health cover Mounjaro for Type 2 Diabetes?

Yes. Priority 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 (preferred drug). See the qualification pathways below.
  • Medicaid: 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 (3 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

All of:

  • Diagnosis of Type 2 diabetes mellitus
  • Patient is at least 18 years of age
  • A1C ≥ 7% and ≤ 9%
  • Trial and failure of, or intolerance to at least 2 oral antidiabetic agents used in combination OR insulin, at maximal daily doses for at least 3 continuous months, in conjunction with diet and exercise per ADA Standards of Care, with inadequate glycemic control — documented within the last 6 months

Documentation to bring

  • Documentation of Type 2 diabetes mellitus diagnosis
  • ICD-10 diagnosis code for type 2 diabetes (E11.0–E11.9) — required on file for Traditional formulary PA
  • A1C lab result showing value ≥ 7% and ≤ 9% (within last 6 months)
  • Documentation of trial and failure of at least 2 oral antidiabetic agents used in combination OR insulin at maximal daily doses for at least 3 continuous months, with inadequate glycemic control, within the last 6 months
  • Documentation that treatment was in conjunction with diet and exercise per ADA Standards of Care

Not covered when

  • Medications in this category are only covered for type 2 diabetes mellitus
  • Type 1 diabetes

Policy note: Mounjaro is listed as a Preferred Agent alongside Trulicity (dulaglutide) under the GLP-1 Receptor Agonists class. The policy explicitly states these medications are only covered for type 2 diabetes mellitus under the Priority Health Optimized and Traditional Formularies. For the Traditional formulary, PA is triggered only if the T2DM ICD-10 code is not already on file; for the Optimized formulary, the full criteria above always apply. No continuation/renewal criteria, quantity limits, or approval duration is stated for GLP-1s in this document. The document does not address weight loss, CV risk reduction, OSA, MASH, or CKD indications for any GLP-1.

Policy effective December 1, 2024 · verified June 10, 2026 · source: 81 Dace8 F00 Ff442799502209 Cc51780 F

Applies to Medicaid plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

Non-preferred agent — base criteria plus clinical exception

All of:

  • Diagnosis of type 2 diabetes
  • Discontinuation of other GLP-1 agonists
  • Discontinuation of DPP-4 inhibitors

Plus any one of:

  • Allergy to preferred medications
  • Contraindication or drug-to-drug interaction with preferred medications
  • History of unacceptable side effects with preferred medications
  • Trial and failure with one preferred medication within same subgroup (GLP-1 agonists)

Documentation to bring

  • Documentation of type 2 diabetes diagnosis
  • Confirmation of discontinuation of other GLP-1 agonists
  • Confirmation of discontinuation of DPP-4 inhibitors
  • Documentation of allergy, contraindication, drug-to-drug interaction, unacceptable side effects, or trial and failure with one preferred GLP-1 agonist

Approval and renewal

  • Initial approval: 12 months

Policy note: Mounjaro is listed as a non-preferred agent. In addition to the base non-preferred criteria (T2DM diagnosis, discontinuation of other GLP-1 agonists and DPP-4 inhibitors), at least one clinical exception must be met: allergy, contraindication/drug interaction, unacceptable side effects, or trial and failure with a preferred GLP-1 agonist. Approval duration is up to 1 year. The preferred GLP-1 agonists in this subgroup are Byetta, Ozempic, Trulicity, and Victoza.

Policy effective May 1, 2025 · verified June 10, 2026 · source: Medicaid Rx PA Criteria · View policy document (PDF)

Open on its own page →

Questions people ask
Does Priority Health cover Mounjaro?
Yes. Priority 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 Priority Health?
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 10, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Priority Health: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: BCBS Michigan, Michigan Medicaid, Molina Healthcare, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid

All insurance plans · All medications

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