Tennessee Medicaid

Does Tennessee Medicaid cover Mounjaro?

Quick answer · Type 2 Diabetes

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

  • Medicaid: Covered (preferred drug). A1C of 6.5% or higher

Last verified June 3, 2026. Policy effective June 1, 2026. Source: Criteria-PDL.pdf. How we verify this data →

Check your card for your exact plan →

Mounjaro for Type 2 Diabetes

What Tennessee Medicaid requires, by plan type. Open this indication on its own page →

Medicaid

Covered (preferred drug)

What you need to qualify

  • A1C of 6.5% or higher
  • Lab results confirming eligibility

Qualification pathways

You can qualify through any one of these.

Initial approval for Type 2 Diabetes

All of:

  • Submission of medical records confirming T2DM diagnosis
  • Will not be used concomitantly with DPP-4 inhibitors
  • Will not be co-administered with another GLP-1 receptor agonist
  • No personal or immediate family history of medullary thyroid carcinoma or MEN2

Plus any one of:

  • A1C >= 6.5%
  • Fasting plasma glucose >= 126 mg/dL
  • 2-hour plasma glucose >= 200 mg/dL during oral glucose tolerance test
  • Random plasma glucose >= 200 mg/dL in patient with classic symptoms of hyperglycemia or hyperglycemic crisis

Documentation to bring

  • Medical records (e.g., chart notes) confirming diagnosis of type 2 diabetes
  • Lab result confirming one of: A1C >= 6.5%, FPG >= 126 mg/dL, 2-hour PG >= 200 mg/dL during OGTT, or random plasma glucose >= 200 mg/dL with classic hyperglycemia symptoms
  • Documentation that patient has no personal or immediate family history of medullary thyroid carcinoma or MEN2

Quantity limits

  • 2.5mg, 5mg, 7.5mg, 10mg, 12.5mg, 15mg — 2 mL

Approval and renewal

  • To renew, the plan looks for improvement in A1C and Positive clinical response required: reduction in HbA1C, HbA1C goal achieved, improvement in fasting blood glucose levels, or improvement in ASCVD. DPP-4 inhibitor exclusion and GLP-1 co-administration exclusion re-verified at renewal.

Not covered when

  • Personal or immediate family history of medullary thyroid carcinoma or MEN2
  • Concomitant use of DPP-4 inhibitors
  • Co-administration with another GLP-1 receptor agonist

Policy note: Quantity limit is 2 mL per 28 days. PA form required: GLP-1 Agonist PA Form. Renewal requires positive clinical response documentation plus re-attestation of DPP-4 and GLP-1 co-administration exclusions. No A1C metformin step therapy or BMI requirement specified.

Policy effective June 1, 2026 · verified June 3, 2026 · source: Criteria-PDL.pdf

Why Mounjaro requests get denied by Tennessee Medicaid

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Mounjaro and Zepbound are the same molecule with different approved uses; a request for Mounjaro under a diagnosis that matches Zepbound is routinely denied.
  2. No recent A1C result on file.

Frequently asked questions

Does Tennessee Medicaid cover Mounjaro?
Tennessee Medicaid covers Mounjaro for type 2 diabetes with prior authorization on Medicaid.
What does Tennessee Medicaid require to renew Mounjaro?
Improvement in A1C and Positive clinical response required: reduction in HbA1C, HbA1C goal achieved, improvement in fasting blood glucose levels, or improvement in ASCVD. DPP-4 inhibitor exclusion and GLP-1 co-administration exclusion re-verified at renewal.
How current is this information?
This page reflects Tennessee Medicaid's written policy as of June 1, 2026, last verified against the source document on June 3, 2026.

Other medications under Tennessee Medicaid

Mounjaro coverage under other plans

All insurance plans · All medications

This page summarizes Tennessee Medicaid's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.