Prior authorization is usually required: Insurance providers typically require prior authorization before covering Mounjaro for insulin resistance, even if the medication is prescribed for weight management and improving hyperglycemia.
Insurance coverage varies widely: Coverage for Mounjaro varies depending on the insurance provider, plan type, and individual coverage details, so it's essential to review your plan's coverage details.
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Medicare Part D and commercial plans often cover Mounjaro: Many major insurance plans, including Medicare Part D and commercial plans, cover Mounjaro for insulin resistance when used as prescribed for weight management and improving hyperglycemia.
High-deductible plans may require significant out-of-pocket costs: Some insurance plans, particularly high-deductible plans, may require patients to pay a significant amount out-of-pocket before coverage kicks in.
Specific criteria may be required for coverage: Insurance plans may have specific criteria that must be met for coverage, such as proof of failed attempts with other medications or lifestyle modifications.
The Mounjaro Savings Card can lower costs: The manufacturer of Mounjaro offers a savings card that can lower the cost to $25 for up to a 3-month supply if you have commercial prescription insurance.
BCBS coverage depends on the specific plan: BCBS (Blue Cross Blue Shield) may cover Mounjaro, but it depends on the specific plan, with some plans listing it as a preferred drug and others as non-preferred.
Without insurance, Mounjaro costs around $1,474 per month: The average monthly cost of Mounjaro without insurance is between $1,000 to $1,200, depending on the pharmacy.
The Mounjaro Savings Card can save up to $573: If your commercial insurance doesn't cover Mounjaro, you can still benefit from the Mounjaro Savings Card, which can save up to $573 for a 1-month prescription.
Insurance coverage for Ozempic varies: Insurance coverage for Ozempic (semaglutide) for insulin resistance also varies, and the cost can be a significant barrier to treatment.
Ozempic retail prices range from $1,000 to $1,200: The retail price of Ozempic ranges from $1,000 to $1,200 or more for one pen, depending on the pharmacy.
FDA approval was given in May 2022: Mounjaro was approved by the US Food and Drug Administration in May 2022 and was expected to go on sale by the end of June 2022.