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Regence

Does Regence cover Mounjaro for Type 2 Diabetes?

Yes. Regence 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.

Route 1: Type 2 Diabetes Diagnosis

All of:

  • Diagnosis of type 2 diabetes (T2DM)

Route 2: Point-of-Sale Clinical Edit (ICD-10 or prior therapy claims)

Plus any one of:

  • ICD-10 code for type 2 diabetes (E11*) within the past 2 years
  • Adjudicated and paid claims for a contingent therapy (biguanides, insulin, amylin analogs, sulfonylureas, meglitinide analogues, alpha-glucosidase inhibitors, DPP-4 inhibitors, insulin sensitizing agents, SGLT2 inhibitors, or antidiabetic combinations) — 56-day supply in 120 days
  • Auto-grandfather: prior paid claim for Mounjaro, Ozempic, Rybelsus, or Trulicity within 120 days

Documentation to bring

  • Diagnosis of type 2 diabetes OR ICD-10 code E11* within past 2 years OR adjudicated claims for qualifying contingent antidiabetic therapy (56-day supply in 120 days)
  • Chart notes or clinical documentation confirming medical necessity and clinical benefit (for continuation)

Quantity limits

  • all available strengths — 4 pens per 28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Clinical documentation (such as chart notes) must confirm that current medical necessity criteria are met and that the medication is providing clinical benefit, such as disease stability or improvement.

Not covered when

  • Diabetic ketoacidosis (DKA)
  • Islet-cell transplantation
  • Use in combination with Symlin (pramlintide) or another GLP-1 agonist-containing medication
  • Weight loss in the absence of coverable medical conditions
  • Type 1 diabetes

Policy note: Policy covers Mounjaro under the pharmacy benefit only (self-administered). Point-of-sale clinical edits in Appendix 1 provide an alternative pathway via ICD-10 code E11* (2-year lookback) or prior paid claims for contingent antidiabetic therapies (56-day supply in 120 days), or auto-grandfather based on prior paid claims for Mounjaro/Ozempic/Rybelsus/Trulicity within 120 days. Authorization reviewed at least annually.

Policy effective April 15, 2026 · verified June 3, 2026 · source: Dru750reg · View policy document (PDF)

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Questions people ask
Does Regence cover Mounjaro?
Yes. Regence 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 Regence?
Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does Regence require to renew Mounjaro?
Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Clinical documentation (such as chart notes) must confirm that current medical necessity criteria are met and that the medication is providing clinical benefit, such as disease stability or improvement.
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 Regence: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: Idaho Medicaid, Kaiser Permanente Northwest, Molina Healthcare, Oregon Medicaid, PacificSource Health, Premera, Washington Medicaid, Elevance Health

All insurance plans · All medications

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