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Wisconsin Medicaid

Does Wisconsin Medicaid cover Mounjaro?

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

Policy document

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

Earliest policy review June 3, 2026. How we verify · Check your exact plan · Medicaid card names in Wisconsin

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 GLP-1 approval for T2DM

All of:

  • Drug is prescribed consistent with FDA-approved labeling
  • Member has type 2 diabetes mellitus
  • HbA1c measured within the past 6 months
  • If not currently on a GLP-1 agent: most recent HbA1c ≥ 6.5%
  • For at least 2 preferred GLP-1 agents: documented trial at maximum dose for ≥ 3 consecutive months with unsatisfactory glycemic response, OR clinically significant adverse drug reaction

Documentation to bring

  • Completed and signed Prior Authorization Drug Attachment for Hypoglycemics, GLP-1 Agents (Form F-00238)
  • Completed PA/RF (Prior Authorization Request Form, F-11018)
  • Copy of member's current medical records documenting the medical condition being treated
  • Details regarding previous GLP-1 medication use (at least 2 preferred GLP-1 agents trialed)
  • Member's current treatment plan
  • Member's current HbA1c lab report (within past 6 months)
  • For step therapy failure pathway: HbA1c measured after member has been taking the maximum dose of a preferred agent for at least 3 consecutive months
  • For adverse reaction pathway: documentation of clinically significant adverse drug reaction with preferred GLP-1 agent(s)

Approval and renewal

  • Initial approval: 6 months
  • Renewal: every 12 months
  • Renewal: Improvement in A1C.
  • Renewal: Member must have been adherent with prescribed treatment regimen AND have a reduction in HbA1c compared to baseline prior to initiation of the non-preferred GLP-1 agent.

Not covered when

  • Nonadherence to previous GLP-1 treatment is not valid criteria
  • Member's fear of needles is not valid criteria
  • Member's or prescriber's preference for an oral agent is not valid criteria
  • Member's or prescriber's preference for the non-preferred GLP-1 agent is not valid criteria
  • Member's or prescriber's preference for less frequent dosing schedule is not valid criteria
  • Type 1 diabetes

Policy note: This is a Wisconsin ForwardHealth (Medicaid) policy. The document covers non-preferred GLP-1 agents as a class; preferred GLP-1 agents require only a valid diagnosis code on claims without a separate PA. The A1C ≥ 6.5% threshold applies only if the member is NOT currently on a GLP-1 agent. Initial PA approved for up to 183 days (~6 months); renewal approved up to 365 days. Step therapy requires trial and failure or adverse reaction with at least 2 preferred GLP-1 agents. The document does not name specific preferred vs. non-preferred agents; Mounjaro is classified as non-preferred based on document context. Mounjaro has a T2DM indication only in this in-scope list; weight loss is not addressed by this document.

verified June 3, 2026 · source: Wisconsin Medicaid Medicaid prior authorization policy · View policy document (PDF)

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Questions people ask
Does Wisconsin Medicaid cover Mounjaro?
Yes. Wisconsin 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 Wisconsin Medicaid?
Type 2 Diabetes — Applies to Medicaid plans. Initial approval: 6 months. Renewal: every 12 months.
What does Wisconsin Medicaid require to renew Mounjaro?
Type 2 Diabetes — Applies to Medicaid plans. Improvement in A1C. Member must have been adherent with prescribed treatment regimen AND have a reduction in HbA1c compared to baseline prior to initiation of the non-preferred GLP-1 agent.
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.

Card and program names on file in Wisconsin

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

Also under Wisconsin Medicaid: Ozempic, Wegovy, Zepbound

Mounjaro under other plans: Elevance Health, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Colorado Medicaid, Connecticut Medicaid, Delaware Medicaid, Florida Medicaid

All insurance plans · All medications

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