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Key takeaways
United Healthcare may cover Mounjaro for Type 2 diabetes but not weight loss, depending on your specific prescription drug benefit plan.
Mounjaro is typically listed as a Tier 2 or 3 medication, making it a mid-range cost drug.
Coverage for Mounjaro may require prior authorization and have quantity limits.
Check your plan’s formulary or contact United Healthcare directly to verify coverage for Mounjaro.
Mounjaro (tirzepatide) is a relatively new medication prescribed for managing blood sugar levels in people with Type 2 diabetes. Many people may rely on this weekly subcutaneous injection to keep their glucose levels in check. However, as a brand-name prescription drug, it may be more expensive than some alternatives, especially since there is no generic version available.
If you’ve been prescribed Mounjaro, you may ask whether your insurance will cover it. Many United Healthcare (UHC) plans may cover Mounjaro, but not all of them. The specifics are likely to depend on your prescription drug benefit plan. You may want to check with your plan provider to verify coverage and cost-sharing specifics.
Does United Healthcare cover Mounjaro?
United Healthcare may cover Mounjaro for Type 2 diabetes. However, there are important details to keep in mind.
First, you need prescription drug coverage as part of your insurance plan if you’re hoping to have it cover Mounjaro. And if you do have prescription drug coverage, it may or may not cover Mounjaro. If it does cover Mounjaro, the actual cost will depend on the specifics of your prescription drug list (PDL) or formulary—a list of drugs organized into tiers. Mounjaro is typically a Tier 2 or 3 medication. It’s not as cheap as a Tier 1 drug, but it’s also not as expensive as a Tier 5 drug.
In addition, coverage for Mounjaro may have certain requirements and limits, such as the following:
- Prior authorization: Your healthcare provider may need to provide a detailed explanation to your insurance company explaining why you need Mounjaro.
- Quantity limits: There may be restrictions on the amount of Mounjaro you can receive at one time. This means you could be limited in how much of the medication you can get with each prescription refill.
- Step therapy: You might need to try other medications first before your insurance will pay for Mounjaro. Some insurance companies would prefer you use a less expensive drug before covering a drug such as Mounjaro. If the less expensive drug doesn’t work, then they’ll reassess whether to cover Mounjaro.
Remember, your exact coverage and costs can vary based on your specific plan. Always check with United Healthcare or your employer’s benefits administrator for the most accurate information.
Does United Healthcare cover Mounjaro for weight loss?
United Healthcare plans may cover Mounjaro if it’s prescribed for Type 2 diabetes. Health insurance plans generally don’t cover Mounjaro for weight loss, as this would be an off-label use.
The active ingredient in Mounjaro, tirzepatide, is available under the brand name Zepbound for weight loss. Zepbound can be used for long-term weight management when combined with a low-calorie diet and increased physical activity. It is approved for adults who:
- Have a BMI of 30 or higher (obesity)
- Have a BMI of 27 or higher (overweight) along with at least one health problem related to weight, like high blood pressure, high cholesterol, Type 2 diabetes, sleep apnea, or heart disease
Like most health insurance plans, United Healthcare plans generally don’t cover weight-loss medications. In many cases, Mounjaro may be excluded from your prescription drug list or formulary if you’re taking it for weight loss. It’s important to check your health plan’s specifics, as coverage can vary.
In some cases, your insurance plan may cover other weight-loss drugs, such as Saxenda (liraglutide) or Wegovy (semaglutide). If your insurer covers Wegovy or Saxenda but these medications are unavailable, your doctor may be able to appeal and request a formulary exception, citing the shortage of the covered drug.
How much does Mounjaro cost?
If you don’t have insurance coverage or your insurance company denies your claim for Mounjaro, you may have to pay the retail cost of the medication. Without insurance, the average retail price of Mounjaro is around $1,460 per fill, which is a one-month supply equal to four pre-filled pens. However, most people don’t end up paying the full list price for their medication.
The retail cost of Mounjaro can vary depending on the quantity you buy and where you buy it. In many cases, you may be able to use manufacturer coupons or other savings options to reduce the cost of Mounjaro.
How to check whether your United Healthcare plan covers Mounjaro
You can check whether your United Healthcare plan covers Mounjaro through various avenues. Here are some potential ways to see if Mounjaro is covered.
Look at your insurance plan’s formulary
One of the first things you can do to check coverage for medications is check your plan’s formulary or prescription drug list. This list can usually be found on United Healthcare’s website or in your plan documents. Search for Mounjaro in the list to see its coverage status.
Contact United Healthcare directly
You can also call United Healthcare’s customer service phone number to be connected with someone who can provide detailed information about drug coverage. Your United Healthcare member ID card might have a phone number for pharmacy benefits. Call this number and ask about the coverage for Mounjaro, and be ready to provide your member ID number to expedite the process.
Check online resources
You can also log into your United Healthcare account online. The account dashboard generally has a section for pharmacy or prescription benefits. Here, you may be able to search for specific medications like Mounjaro to see whether your specific plan covers it and, if so, how much it will cost.
Speak to your pharmacist
Your pharmacist can help you determine whether your United Healthcare plan covers Mounjaro. They can explain how much it might cost you and if there are any ways to save money. Don’t hesitate to ask them for advice and information. They have access to your healthcare plan details and can verify insurance coverage.
Check regularly for coverage updates
Drug coverage can change, so it’s important to check regularly. United Healthcare may also periodically mail or email notices about changes in coverage.
How to save on Mounjaro
If your insurance doesn’t cover Mounjaro or out-of-pocket costs are too high, there are several ways to save. These methods include discount cards, savings programs, and assistance options that may help reduce costs.
Use a SingleCare discount card
A SingleCare discount card can offer savings on Mounjaro prescriptions. You can visit the SingleCare website and search for Mounjaro. Once there, you can compare prices at various pharmacies and choose the most affordable option.
Mounjaro prices start at around $940 with SingleCare, depending on the pharmacy you select. Once you find the best price, print or download the discount card and present it at the pharmacy. Remember that prices can change, so it’s a good idea to check frequently.
Use a Mounjaro savings card from the manufacturer
The Mounjaro Savings Card from its manufacturer, Eli Lilly and Company, may help reduce costs for eligible patients who have commercial health insurance. If eligible, they can use the card to pay as little as $25 for a one-month or three-month prescription.
The savings card can cover up to $573 for a one-month prescription and has an annual limit of $3,438. It’s important to check the card’s terms and conditions, as the program details may change. This card can be used for up to six prescriptions per year, offering a practical way to manage costs.
Use a mail-in rebate
Keep an eye out for mail-in rebates offered by the manufacturer or other organizations. These rebates work by reimbursing a portion of the cost after you purchase the medication.
To get a mail-in rebate, you’ll need to follow specific instructions, which often include filling out a form and providing proof of purchase. Rebates may not always be available, so it’s important to check periodically for any current offers that could help reduce the overall cost of Mounjaro.
Use Medicare Extra Help
If you have a Medicare plan that covers Mounjaro for Type 2 diabetes, you may be able to use the Medicare Extra Help program to help pay for your Medicare Part D premiums, deductibles, and other costs. Some people qualify for the program automatically, such as if they have full Medicaid coverage, state assistance for Part B premiums, or supplemental Social Security income.
RELATED: Does Medicare cover Mounjaro?
Compare prices at pharmacies
Prices for Mounjaro can vary greatly between pharmacies. Comparing prices can help you find the best deal. Although you can call local pharmacies individually to ask what the current price is, it is quicker to use SingleCare’s drug price look-up tool or its Mounjaro coupon page to view a list of local pharmacies with their current Mounjaro costs. Then, you can choose to have your Mounjaro prescription filled at the pharmacy offering the lowest cost. Regularly checking prices ensures you’re getting the best deal possible.
Consult a healthcare provider for potential alternatives
Healthcare providers can offer advice and recommend different medications if cost is a concern. They may prescribe a different, less expensive medication that works similarly to Mounjaro. You can consult your healthcare provider to ensure you know all your options and choose the most cost-effective treatment plan.
Sources
- Mounjaro highlights of prescribing information, Eli Lilly and Company (2023)
- Prescription drug lists, United Healthcare (2024)
- Step therapy (fail first), National Organization for Rare Disorders (2024)
- Prescription drug lists (PDLs) For fully insured commercial plans (non-exchange), Eli Lilly and Company (2024)
- Savings & support for Mounjaro, Eli Lilly and Company (2024)
- Help with drug costs, Centers for Medicare and Medicaid Services