WHETHER YOU’RE TAKING THIS NEW MEDICATION FOR TYPE 2 DIABETES OR WEIGHT LOSS, THESE FIVE STRATEGIES CAN MAKE IT A LITTLE EASIER ON YOUR WALLET
[Mounjaro (tirzepatide)] is a prescription medication from Eli Lilly that is FDA-approved to help control blood sugar in adults and children ages 10 and older with Type 2 diabetes, when used alongside diet and exercise. Although it has become widely known for its weight-loss effects, Mounjaro itself is not FDA-approved specifically for weight management.
Clinical trials have reported substantial weight reductions among people taking Mounjaro, with some participants losing more than 20% of their body weight. Because of these effects, some healthcare providers prescribe Mounjaro off-label for weight loss. The same active ingredient, tirzepatide, is available in Zepbound, which is FDA-approved for weight management and obstructive sleep apnea.
Cost can be another consideration, particularly for people who don’t have insurance or whose prescription coverage doesn’t include Mounjaro when it is being used for weight loss. Fortunately, there may be ways to reduce the out-of-pocket cost, depending on your insurance coverage and available savings options.
Key Takeaways
- Mounjaro (tirzepatide) is FDA-approved to treat Type 2 diabetes and may also be prescribed off-label for weight loss.
- Insurance coverage for weight loss may be limited, which can leave some people paying more out of pocket.
- Depending on eligibility and availability, you may be able to reduce the cost by comparing pharmacy prices, using available prescription savings programs, or discussing alternative treatments with your healthcare provider.
How Much Does Mounjaro Cost?
Without insurance or discounts, the average retail price of Mounjaro is around $1,352 for a one-month supply. Since Mounjaro is administered once a week, a monthly supply generally consists of four doses.
Your actual cost can vary depending on several factors, including:
- Where you live
- The pharmacy you use
- Your prescribed dose
- Your health insurance coverage
Is Mounjaro Covered by Insurance?
Insurance coverage depends on your individual plan. Many insurance plans cover Mounjaro when it is prescribed for its FDA-approved use—treating Type 2 diabetes. However, coverage isn’t guaranteed, so checking your specific plan is the best way to determine your expected cost.
Some insurers require prior authorization, meaning your healthcare provider must submit information showing that you meet the plan’s requirements for coverage.
Coverage may be denied when Mounjaro is prescribed for an off-label purpose, such as weight loss. Zepbound contains the same active ingredient, tirzepatide, and has FDA-approved indications for weight management and obstructive sleep apnea. Depending on the plan, an insurer may cover one medication but not the other.
Understanding your insurance tier
Your insurance company’s formulary lists the medications it covers and assigns them to different payment tiers. Lower tiers generally have lower costs, while higher tiers tend to involve greater out-of-pocket expenses.
When Mounjaro is covered, it may be placed in a middle tier, such as Tier 2 or Tier 3.
To estimate what you’ll pay:
- Check your insurance formulary to see which tier includes Mounjaro.
- Review your plan’s summary of benefits to determine the copay or coinsurance for that tier.
- Check whether you must meet your annual prescription deductible before the copay applies.
For example, if Mounjaro is listed as Tier 2 and your plan charges a $35 copay for Tier 2 medications, your cost could be $35 once any applicable deductible requirements have been met.
Does Medicare Cover Mounjaro?
Some Medicare Part D plans cover Mounjaro, but coverage varies between plans. If your plan covers it, your copay or coinsurance will depend on the medication’s assigned tier and the terms of your plan.
For 2026, Medicare Part D has an annual $2,100 out-of-pocket limit for covered prescription drugs. If your plan doesn’t cover Mounjaro, money you spend on the medication generally won’t count toward that limit.
The source also notes that Mounjaro is not included in the Medicare GLP-1 Bridge program.
Does Medicaid Cover Mounjaro?
Medicaid coverage differs by state. Many state Medicaid programs cover medications used to treat Type 2 diabetes, but Mounjaro coverage isn’t guaranteed.
Check with your specific state Medicaid program to determine whether Mounjaro is covered and what your out-of-pocket cost would be.
Can You Get Mounjaro for Free?
For people with commercial insurance who are prescribed Mounjaro for Type 2 diabetes, insurance may potentially cover the full cost, depending on the plan.
However, Mounjaro may be classified as a non-preferred medication and could require prior authorization before coverage is approved.
Ways to Save Money on Mounjaro
If you don’t have insurance or your plan doesn’t cover the medication, there may still be ways to reduce your costs.
1. Compare available prescription savings
Prescription discount programs may offer lower cash prices at participating pharmacies. Prices can differ based on the dose, quantity, pharmacy, and location, so check the exact prescription before deciding where to fill it.
Discount programs generally cannot be combined with insurance or other discounts.
2. Check the Mounjaro Savings Card
Eli Lilly offers a Mounjaro Savings Card for eligible people with Type 2 diabetes and qualifying commercial insurance.
According to the source, eligible patients may pay as little as $25 for up to a three-month prescription, subject to the program’s requirements and savings limits.
Eligibility requirements include being at least 18 years old, living in the U.S. or Puerto Rico, and having eligible commercial insurance.
The program does not apply to government insurance beneficiaries such as Medicare or Medicaid.
3. Look into Medicare Extra Help
People with Medicare who meet certain income requirements may qualify for Extra Help, a program designed to reduce prescription drug costs.
Eligible individuals may receive assistance with Part D premiums and lower pharmacy costs.
4. Compare pharmacy prices
The same prescription can have different prices at different pharmacies. Comparing several pharmacies may help you find a lower cash price.
You can also ask whether purchasing a larger supply, when medically and insurance-appropriate, changes the price.
5. Ask about lower-cost alternatives
If Mounjaro is too expensive, ask your healthcare provider whether another medication could provide appropriate treatment at a lower cost.
Potential alternatives for Type 2 diabetes mentioned in the source include:
- Victoza
- Liraglutide
- Jardiance
- Farxiga
- Invokana
- Rybelsus
- Trulicity
- Ozempic
- Januvia
- Metformin
The appropriate alternative depends on your medical condition, treatment goals, insurance coverage, and other medications.
Is There a Cheaper Alternative to Mounjaro?
There isn’t currently a generic version of Mounjaro. However, other medications may be appropriate alternatives.
The source notes that medications such as Ozempic (semaglutide), Trulicity (dulaglutide), and Victoza (liraglutide) are commonly used for Type 2 diabetes. Some medications, including Saxenda and Wegovy, have FDA-approved weight-loss indications, while other medications may be used off-label for weight management.
Your healthcare provider can help determine whether a different medication would be effective and more affordable for you.
Common Mounjaro Side Effects
Possible side effects include:
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Reduced appetite
- Stomach pain
- Indigestion
Following your provider’s instructions may help minimize side effects. Discuss other medications and possible interactions with your healthcare provider.
Seek emergency medical attention if you develop signs of a serious allergic reaction.
Important Mounjaro Safety Warning
Mounjaro carries a boxed warning, the FDA’s strongest warning for prescription medications. Animal studies found an association between tirzepatide and a type of thyroid cancer.
Mounjaro should not be used by people with a personal or family history of medullary thyroid carcinoma (MTC) or by people with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Always use Mounjaro exactly as prescribed and don’t stop treatment without first discussing it with your healthcare provider.
Source: SingleCare