Does Texas Medicaid cover Mounjaro?

Quick answer · Type 2 Diabetes

Texas Medicaid covers Mounjaro for type 2 diabetes with prior authorization on Medicaid.

The card and program names below are mapped to Texas Medicaid in our records. Coverage depends on the reason for treatment and the requirements in the policy.

Policy last verified June 4, 2026. Policy effective October 31, 2025. Source: glp1RApending.pdf. How we verify this data.

Card and program names on file in Texas

Select a name to read the Texas Medicaid policy for Mounjaro. These are names we recognize, including older names and spelling variants; this is not a list of plans currently accepting members.

Don't see your card name? Check your card or call the pharmacy-benefit number on your card. If you also have Medicare, confirm which plan handles this prescription.

Mounjaro for Type 2 Diabetes

Medicaid

Covered with requirements

What you need to qualify

  • Age 18 and older
  • Diagnosis documented with a code (E1100, E1101, E1121, E1122, E1129, E11311, E11319, E11321, E11329, E11331, E11339, E11341, E11349, E11351, E11359, E1136, E1139, E1140, E1141, E1142, E1143, E1144, E1149, E1151, E1152, E1159, E11610, E11618, E11620, E11621, E11622, E11628, E11630, E11638, E11641, E11649, E1165, E1169, E118, E119)
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Standard pathway: prior oral antidiabetic agent use

All of:

  • Age >= 18 years
  • Diagnosis of type 2 diabetes in the last 365 days
  • History of an oral antidiabetic agent for 14 consecutive days in the last 365 days
  • No history of ESRD, pancreatitis, gastroparesis, MTC, or MEN2 in the last 730 days
  • No history of ESRD services (CPT codes) in the last 730 days
  • HbA1c test in the last 180 days
  • No concurrent therapy with a GLP-1 RA containing agent

Alternative pathway: history of requested medication (stable therapy)

All of:

  • Age >= 18 years
  • Diagnosis of type 2 diabetes in the last 365 days
  • History of the requested medication for 14 consecutive days in the last 365 days
  • No history of ESRD, pancreatitis, gastroparesis, MTC, or MEN2 in the last 730 days
  • No history of ESRD services (CPT codes) in the last 730 days
  • HbA1c test in the last 180 days
  • No concurrent therapy with a GLP-1 RA containing agent

Documentation to bring

  • Type 2 diabetes diagnosis (ICD-10 code from Table 3) within last 365 days
  • History of oral antidiabetic agent for 14 consecutive days in the last 365 days (Table 4) OR history of requested medication for 14 consecutive days in the last 365 days (Table 5)
  • HbA1c test (CPT 83036 or 83037) within the last 180 days
  • Absence of ESRD, pancreatitis, gastroparesis, MTC, or MEN2 diagnosis in the last 730 days
  • Absence of ESRD services (CPT codes from Table 9) in the last 730 days
  • No concurrent GLP-1 RA-containing agent therapy

Approval and renewal

  • Initial approval: 12 months

Not covered when

  • ESRD (diagnosis or ESRD services CPT codes in last 730 days)
  • Pancreatitis (acute or chronic, in last 730 days)
  • Gastroparesis (in last 730 days)
  • Medullary thyroid carcinoma (MTC) (in last 730 days)
  • Multiple endocrine neoplasia syndrome type 2 (MEN2) (in last 730 days)
  • Concurrent therapy with a GLP-1 RA containing agent
  • Type 1 diabetes

Policy note: This is a Texas Medicaid (Texas Prior Authorization Program) policy administered by Acentra Health. Mounjaro is only eligible for patients >= 18 years of age (no pediatric exception unlike Trulicity/Victoza). The policy does not specify an A1C threshold for approval, only requires evidence of an HbA1c test within 180 days. The oral antidiabetic agent step therapy requirement can be bypassed if the patient has an established history of the requested medication (14 consecutive days in last 365 days). Wegovy and Zepbound appear only in Table 11 (GLP-1 RA containing agents — used to check for duplicate therapy); the document does NOT establish PA criteria for their weight_loss or other in-scope indications. No quantity limits are specified in this document.

Policy effective October 31, 2025 · verified June 4, 2026 · source: glp1RApending.pdf

Full Texas Medicaid coverage page for Mounjaro

Other medications under Texas Medicaid

All insurance plans · All medications

This page summarizes written Medicaid policies on file. It is not a guarantee of coverage or medical advice. Confirm your current benefits and prior-authorization requirements with your plan.