What happens if Mounjaro isn't covered by insurance?
If you have not fully met your yearly deductible, or if the drug is not covered, you may be responsible for the full monthly cost of this drug, which may be over $1000. Coverages will vary among plans.
- Talk to your medical team. ...
- Review your insurance plan's formulary. ...
- Obtain a prior authorization if required. ...
- Request an appeal if necessary.
Manufacturer copay program
If your insurance plan doesn't cover your medication, the maker of the drug may offer cost-reduction options. Some pharmaceutical companies provide manufacturer coupons and patient assistance programs. Manufacturer coupons reduce your out-of-pocket costs.
Novo Nordisk also offers a patient assistance program that provides Ozempic at no cost. To be eligible, you must be a U.S. citizen or legal resident with a total household income at or below 400% of the federal poverty line.
To handle a Mounjaro health insurance denial, you should start with the appeal process recommended by your insurance company. But before doing so, you need to determine whether your insurance plan is an ERISA or non-ERISA plan. If your health insurance is sponsored by your employer, it is likely an ERISA plan.
You can usually find the number to call on the back of your card. Eli Lilly, the manufacturer of Mounjaro offers a copay card program for patients with commercial prescription drug insurance who qualify, even if their insurance plan does not cover Mounjaro. You may pay as little as $25 for up to a 3-month supply.
Depending on your eligibility, you may pay only $25 for a 1-month or 3-month supply of Mounjaro. Unfortunately, the Mounjaro Savings Card is only available to people with commercial health insurance.
There are currently no generic alternatives for Mounjaro . It is covered by some Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower. Get Mounjaro for as low as $1,044.39, which is 18% off the average retail price of $1,269.19 for the most common version, by using a GoodRx coupon.
Mounjaro is more expensive than Ozempic. In early 2024, the cost of Ozempic without insurance started at around $935 a month in the U.S. Mounjaro's list price was $1,069 per fill, according to the Eli Lilly website. Some reports say the drug can cost as much as $1,267.
Payers tend not to cover weight loss medications. This goes for commercial insurers as well as Medicare and Medicaid. In fact, Medicare is prohibited by law from covering them. Many insurers and employers who sponsor health coverage consider weight loss a cosmetic need rather than a medical one.
How much is Ozempic without insurance?
Novo Nordisk (the manufacturer of Ozempic) lists Ozempic at $935.77 per month. This list price reflects the cost of Ozempic without health insurance. Ozempic is an injectable medication. Patients use prefilled injection pens once weekly to manage blood glucose (blood sugar) and obesity.
But that may not translate to wider insurance coverage of the weekly injection drug from Novo Nordisk and similar obesity treatments just yet. Some employers and other health plans are still reluctant to cover Wegovy due to its hefty $1,350 monthly price tag, which they say could significantly strain their budgets.
How to get Mounjaro for $25. Some people with insurance will be eligible for Lilly's Mounjaro Savings Card, which starts at $25 for a 1- or 3-month prescription. A 1-month supply includes 4 pens across 28 days. A 3-month supply includes up to 12 pens for 84 days.
What support resources are there for MOUNJARO ®? You can contact the Mounjaro patient services support center at 1-833-807-MJRO (833-807-6576).
Mounjaro can help manage type 2 diabetes symptoms and promote weight loss. Getting a prescription online may be faster, more convenient, and more discreet than visiting a doctor's office in person. People can get a Mounjaro prescription online through telehealth companies.
The only way to get free samples of Mounjaro is from a healthcare provider who can request samples directly from Eli Lilly as long as the drug isn't in short supply. Without insurance or discounts, the average out-of-pocket cost of Mounjaro is around $1,498 per month.
Still, some studies suggest that the active ingredient in Mounjaro may be more effective at reducing weight and controlling blood sugar levels than Wegovy's. In a 68-week trial, patients using tirzepatide at doses of 10 and 15 mg lost up to 5.92% more weight than those taking 2.4 mg of semaglutide.
Sometimes the patient's health plan may require a prior authorization (PA) before covering Mounjaro. It is important to provide the correct information to ensure there are no delays in treatment.
In addition to high costs, companies don't have long-term data on effectiveness and potential side effects to support coverage, and some are just biding their time until more of this information exists.
Typically, a type 2 diabetes diagnosis is required for insurance approval of Mounjaro. If you don't have diabetes but want to take Mounjaro for weight loss, your healthcare professional will decide if Mounjaro is a safe and appropriate choice based on your health needs.
Is Mounjaro a tier 3 drug?
Medicare prescription drug plans typically list Mounjaro on Tier 3 of their formulary.
Mounjaro is only available as a brand-name drug. It doesn't come in a generic version.
“Studies have shown more weight loss with Mounjaro® than Ozempic™,” says Dr. Johnson-Rabbett. “Both are powerful tools to support weight loss. A BMI of 27 or more with weight-related comorbidities or a BMI of 30 or greater is needed for the use of weight loss drugs to be indicated.”
Top Mounjaro alternatives for diabetes include Ozempic (semaglutide), Rybelsus (semaglutide), and Trulicity (dulaglutide). Available alternatives for weight loss include Zepbound (tirzepatide), Wegovy (semaglutide), and Saxenda (liraglutide).
Overweight and obese adults who took the injected medication Mounjaro lost more weight and were more likely to meet specific weight loss targets than people on a similar competitor, Ozempic, according to a new study of people taking the drugs in the real world.
