Does Washington Medicaid cover Mounjaro?

Quick answer · Type 2 Diabetes

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

The card and program names below are mapped to Washington 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 June 1, 2026. Source: antidiabetics-GLP-1-agonists.pdf. How we verify this data.

Card and program names on file in Washington

Select a name to read the Washington 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 10 and older
  • A1C of 6.5% or higher
  • Trial of metformin for at least 90 days, or a documented reason it can't be used (["intolerance", "contraindication", "clinically_inappropriate"])
  • Prior trial of another GLP-1 medication (liraglutide) for at least 90 days
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Non-preferred agent (Mounjaro) for T2DM — initial approval

All of:

  • Diagnosis of type 2 diabetes OR HbA1c ≥ 6.5 within the last 12 months
  • Patient is ≥ 10 years old
  • Drug will not be used in combination with another GLP-1 agonist or DPP4 inhibitor
  • History of failure (inability to achieve HbA1c < 7%) on metformin at maximum or highest tolerated dose for a minimum of 90 continuous days (unless not tolerated, contraindicated, or clinically inappropriate)
  • History of failure (inability to achieve HbA1c < 7%) on liraglutide at maximum or highest tolerated dose for a minimum of 90 continuous days (unless not tolerated, contraindicated, or clinically inappropriate)

Documentation to bring

  • Diagnosis of type 2 diabetes OR HbA1c lab result ≥ 6.5 within the last 12 months
  • Documentation of patient age (≥ 10 years)
  • Documentation confirming drug will not be combined with another GLP-1 agonist or DPP4 inhibitor
  • Documentation of metformin trial at maximum or highest tolerated dose for ≥ 90 continuous days with inadequate response (HbA1c not achieving <7%), OR documentation of intolerance/contraindication/clinical inappropriateness
  • Documentation of liraglutide trial at maximum or highest tolerated dose for ≥ 90 continuous days with inadequate response (HbA1c not achieving <7%), OR documentation of intolerance/contraindication/clinical inappropriateness

Quantity limits

  • 2.5mg/0.5mL — 2 mL per 28 days
  • 5mg/0.5mL — 2 mL per 28 days
  • 7.5mg/0.5mL — 2 mL per 28 days
  • 10mg/0.5mL — 2 mL per 28 days
  • 12.5mg/0.5mL — 2 mL per 28 days
  • 15mg/0.5mL — 2 mL per 28 days

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • To renew, the plan looks for improvement in A1C and HbA1c ≤ 7 OR improved from baseline prior to GLP-1 treatment; diagnosis of T2DM confirmed; not used in combination with another GLP-1 agonist or DPP4 inhibitor. BMI and prior therapy step requirements are NOT re-verified at continuation.

Not covered when

  • Concurrent use with another GLP-1 agonist
  • Concurrent use with a DPP4 inhibitor

Policy note: Mounjaro is a non-preferred agent. Minimum age is 10 years (pediatric approval per version 27.17.00-4 update). Adult max dose is 15 mg weekly; pediatric max dose is 10 mg weekly. Step-through requires BOTH metformin AND liraglutide (preferred agents). This standard T2DM entry applies when OSA is NOT present — the OSA-specific indication has separate criteria captured separately. Rybelsus (oral semaglutide) is listed in the medical necessity table but is in-scope only for the diabetes indication under Ozempic brand — Rybelsus criteria appear to mirror the same class criteria as it is listed alongside Ozempic (semaglutide) under the same drug entry in the policy table; however per rule 27 and the in-scope list, Rybelsus is not a separately tracked brand in scope.

Policy effective June 1, 2026 · verified June 4, 2026 · source: antidiabetics-GLP-1-agonists.pdf

Full Washington Medicaid coverage page for Mounjaro

Other medications under Washington Medicaid

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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.