Mounjaro is a medicine that helps people with type 2 diabetes control their blood sugar levels. It’s given as a weekly injection, which works by increasing insulin production, reducing liver sugar production, and slowing down digestion to make you feel fuller for longer.
People are also using Mounjaro to help them lose weight, especially if they’re overweight or obese. This has led to it being approved for weight management under a different brand name called Zepbound.
As more people want to use Mounjaro for weight loss, it’s affecting how health insurance companies cover the cost of this medicine.
CVS Caremark is one such company that helps manage pharmacy benefits. If you’re considering using Mounjaro, understanding its coverage with CVS Caremark is important.
CVS Caremark requires prior authorization for Mounjaro (tirzepatide) with a quantity limit. Mounjaro is FDA-approved as an adjunct to diet and exercise for improving glycemic control in adults with type 2 diabetes mellitus. It is not indicated for weight loss.
Authorization is granted for patients with type 2 diabetes who have not been on a stable dose of the requested drug for at least 3 months and meet specific criteria, such as inadequate treatment response or intolerance to metformin. Continuation of therapy requires demonstrated reduction in A1C since starting the drug. Quantity limits are 4 single-dose pens or vials per 21 days or 12 single-dose pens or vials per 63 days.
CVS Caremark covers Mounjaro (tirzepatide) under specific conditions. Prior authorization is required for initial therapy. The patient must have a diagnosis of type 2 diabetes mellitus.
Authorization may be granted if the patient has not been on a stable dose of the requested drug for at least 3 months and meets one of the following criteria: inadequate treatment response, intolerance, or contraindication to metformin, or requires combination therapy with an A1C of 7.5% or greater. Continuation of therapy requires demonstration of a reduction in A1C since starting Mounjaro. Quantity limits apply, with 4 single-dose pens or vials per 21 days or 12 single-dose pens or vials per 63 days.
Weight loss is not a primary indication for Mounjaro.
Mounjaro is a medication used to control blood sugar levels in people with type 2 diabetes and has been approved for weight management under the brand name Zepbound.
However, CVS Caremark covers Mounjaro primarily for type 2 diabetes management, not for weight loss.
Prior authorization is required for initial therapy, and patients must meet specific criteria such as inadequate treatment response or intolerance to metformin.
Quantity limits apply, with 4 single-dose pens or vials per 21 days or 12 single-dose pens or vials per 63 days.
It’s essential to note that weight loss is not a primary indication for Mounjaro, and patients should consult their healthcare provider for guidance on using this medication.