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Washington Medicaid

Does Washington Medicaid cover Mounjaro for Type 2 Diabetes?

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

Policy on file; the document isn't available to view online yet.

  • Medicaid: Covered with requirements. See the qualification pathways below.

Earliest policy review June 4, 2026. How we verify · Check your exact plan · Medicaid card names in Washington

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.

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
  • Renewal: Improvement in A1C.
  • Renewal: 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

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Questions people ask
Does Washington Medicaid cover Mounjaro?
Yes. Washington 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 Washington Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 12 months. Renewal: every 12 months.
What does Washington Medicaid require to renew Mounjaro?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. 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.
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.

Card and program names on file in Washington

These names map to Washington Medicaid, including older names and spelling variants. This is not a list of plans currently accepting members.

Also under Washington Medicaid: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: Kaiser Permanente Northwest, Molina Healthcare, Premera, Regence, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid

All insurance plans · All medications

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