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South Carolina Medicaid

Does South Carolina Medicaid cover Mounjaro for Type 2 Diabetes?

Yes. South Carolina 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

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.

Adult initial approval for T2DM (non-preferred product)

All of:

  • Age ≥ 18 years
  • Documented diagnosis of T2DM
  • Trial and failure (e.g., A1C goal not met), intolerance, or contraindication to metformin (90-day lookback for paid claims in history)
  • Documentation of baseline A1C within the previous 3 months
  • Requested dose does not exceed the maximum FDA-approved dose for treatment of diabetes mellitus
  • Trial and failure of at least one preferred product (Ozempic, Trulicity, or Victoza), OR rationale as to why preferred products cannot be used

Documentation to bring

  • Documented diagnosis of T2DM
  • Evidence of metformin trial and failure, intolerance, or contraindication (90-day lookback for paid claims in history)
  • Baseline A1C lab result within the previous 3 months
  • Confirmation that requested dose does not exceed maximum FDA-approved dose for diabetes
  • Documentation of trial and failure of a preferred product (Ozempic, Trulicity, or Victoza), OR clinical rationale why preferred products cannot be used

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: Improvement in A1C.
  • Renewal: Reduction in A1C from baseline, OR A1C goal achieved, OR improvement in fasting blood glucose levels. Supporting documentation within the previous 3 months required. Patient must not have experienced any treatment-restricting adverse events.

Policy note: Mounjaro is listed under 'Other Products' and is a non-preferred agent. It requires the same base criteria as preferred products (Ozempic, Trulicity, Victoza) PLUS a trial or failure of a preferred product, or rationale for why preferred products cannot be used. The document does not explicitly state that prior glp1_trial duration must meet a specific threshold — only that a trial and failure occurred. The document does not address Mounjaro for weight loss indication at all; no entry emitted for that.

Policy effective May 1, 2026 · verified June 4, 2026 · source: Sc Rx P Acriteria Glp1s · View policy document (PDF)

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Questions people ask
Does South Carolina Medicaid cover Mounjaro?
Yes. South Carolina 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 South Carolina Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.
What does South Carolina Medicaid require to renew Mounjaro?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. Reduction in A1C from baseline, OR A1C goal achieved, OR improvement in fasting blood glucose levels. Supporting documentation within the previous 3 months required. Patient must not have experienced any treatment-restricting adverse events.
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.

Also under South Carolina Medicaid: Ozempic

Mounjaro under other plans: Molina Healthcare, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, Florida Medicaid

All insurance plans · All medications

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