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Tennessee Medicaid

Does Tennessee Medicaid cover Mounjaro for Type 2 Diabetes?

Yes. Tennessee Medicaid covers Mounjaro for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Medicaid: 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 (1 plan type)

Applies to Medicaid plans.

Covered (preferred drug)

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

  • Renewal: Improvement in A1C.
  • Renewal: 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 · View policy document (PDF)

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Questions people ask
Does Tennessee Medicaid cover Mounjaro?
Yes. Tennessee Medicaid covers Mounjaro for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
What does Tennessee Medicaid require to renew Mounjaro?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. 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?
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 Tennessee Medicaid: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: BCBS Tennessee, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, Florida Medicaid

All insurance plans · All medications

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