There are a number of diabetes medications out there. Your doctor may prescribe one or multiple drugs for you based on your specific condition. One popular drug is Mounjaro, a prescription injection for people with type 2 diabetes. 

76% of Medicare drug plans cover Mounjaro, so it’s important to check your plan’s formulary carefully before ordering the medication. Without insurance, Mounarjaro is costly. In this article, we’ll discuss how Mounjaro works and what to expect for Medicare coverage. 

Key takeaways:

  • Many, but not all, Medicare prescription plans cover Mounjaro. Check your policy details to see if your insurance covers the diabetes drug.

  • Your deductible and copay/coinsurance depends on what drug plan you have. As a brand name drug, Mounjaro tends to have more expensive copays.

  • If Mounjaro is too expensive, not covered by your  drug plan, or doesn’t work for you, there are alternatives. You can talk to your doctor about other options. 

What is Mounjaro?

Mounjaro is the brand name for the prescription drug, tirzepatide, that treats type 2 diabetes. Unlike other diabetes injections, like Ozempic and Wegovy, which only target GLP-1, Mounjaro targets two hormones, GIP and GLP-1. This helps to improve blood sugar levels and control your glycemic index. Doctors often recommend the medication along with diet and exercise.

How does Mounjaro work?

Mounjaro controls blood sugar levels by boosting the body’s natural insulin production after eating and reducing the amount of sugar in the liver. It may be a more comprehensive option compared to other medications since it targets two different hormones to improve blood sugar control.

Does Medicare cover Mounjaro?

Most, but not all, Medicare drug plans cover Mounjaro. The prescription could cost upwards of $1,200 without coverage, so it’s very important to check your plan’s drug list to see if it pays for Mounjaro. 

Your specific costs of Mounjaro can vary depending on your plan. Since Mounjaro is a brand name drug, your out-of-pocket costs for the medication will be higher. Each plan sets their drug prices differently, so it’s important to understand how your plan covers Mounjaro. Check your plan’s summary of benefits to see how much you’ll have to pay for Mounjaro.

There are other alternatives to Mounjaro for diabetes management. Talk to your doctor about what’s best for your needs. If you respond  to one medication better than another, Mounjaro is too expensive for you, or your plan doesn’t cover the drug, you can ask your doctor about other treatments or generic options that may work similarly. 

Medicare coverage for diabetes equipment and treatment  

  • Doctor visits

  • Diabetes supplies

  • Insulin and insulin pumps

  • Therapeutic shoes or inserts

  • Preventive services and counseling

  • Nutritional services

People who qualify can participate in the Medicare diabetes prevention program, which includes a free weekly educational course about diabetes prevention and healthy lifestyles, group support, and a motivational coach. 

How to find drug coverage for your healthcare needs

Not every drug plan includes coverage for the medications that you need. Also, plans have different out-of-pocket costs that can affect how much you pay for your prescriptions. These factors can make it difficult to find Medicare Part D coverage that minimizes your prescription costs. Our Medicare Advisors are here to simplify your search and match you with the right drug plan. Call us at 855-900-2427 or schedule a time to chat for free, tailored guidance in choosing the right plan for your needs.

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