Does Medicare Part D cover Mounjaro?
Coverage, cost, and 2026 details for Mounjaro (tirzepatide) under Medicare Part D.
Quick answer: Yes, Mounjaro is generally covered by Medicare Part D plans, typically on Tier 3 (preferred brand) or Tier 4. Coverage details, copays, and restrictions vary by plan, so compare plans available in your area to find the best coverage for your medications.
What is Mounjaro?
Mounjaro (tirzepatide) is a once-weekly injectable approved for adults with type 2 diabetes. It's a dual GIP and GLP-1 receptor agonist — the first medication in this newer class. Note that Zepbound is the same active ingredient (tirzepatide) but FDA-approved specifically for weight loss; Medicare does not cover Zepbound for weight loss.
Is Mounjaro covered by Medicare Part D?
Many Medicare Part D plans now cover Mounjaro for type 2 diabetes, often on Tier 3 or Tier 4. Because it's a newer drug, formulary coverage varies more than older medications. Most plans require prior authorization. Mounjaro is not covered when prescribed off-label for weight loss.
Typical formulary tier
Mounjaro is most often listed on Tier 3 (preferred brand) or Tier 4 of Part D formularies. The exact tier — and the copay — depends on the specific plan you're enrolled in.
Weight loss vs. diabetes coverage
By federal law, Medicare Part D cannot cover medications when prescribed solely for weight loss. Mounjaro is covered when prescribed for type 2 diabetes (or for cardiovascular benefit when applicable). Your prescriber must document the appropriate medical indication.
How much does Mounjaro cost with Medicare Part D?
Without insurance, Mounjaro costs around $1,100 per month at retail pharmacies. With Medicare Part D coverage, you typically pay $40 to $500 per month before reaching the $2,100 cap.
Your actual cost depends on:
- Your plan's deductible — up to $615 in 2026
- The tier Mounjaro is on in your plan's formulary
- Whether you've reached the $2,100 annual out-of-pocket cap
- Whether you qualify for Extra Help (Low-Income Subsidy)
- Whether you've enrolled in the Medicare Prescription Payment Plan (M3P), which spreads costs across the year
How to lower your Mounjaro costs
1. Compare Part D plans for your specific drugs
The same drug can cost dramatically different amounts on different plans. During the Annual Enrollment Period (October 15 – December 7), use the Medicare.gov Plan Finder to compare what Mounjaro would cost across every plan available in your ZIP code.
2. Check if you qualify for Extra Help
If your income is below approximately $23,475 (single) or $31,725 (married couple) in 2026, you likely qualify for Extra Help, which dramatically reduces what you pay for Mounjaro and all your medications. Learn about Extra Help →
3. Use the Medicare Prescription Payment Plan (M3P)
M3P doesn't lower your total cost, but it spreads your annual out-of-pocket costs into monthly installments — which can help if Mounjaro causes a big upfront pharmacy bill. Learn about M3P →
4. Look into Patient Assistance Programs
Eli Lilly may offer a Patient Assistance Program for people with limited income who don't qualify for Extra Help. These programs can provide free or deeply discounted medication directly from the manufacturer. Learn more about manufacturer programs →
5. Ask about alternatives
Talk to your doctor about whether a different medication — including a generic version or a similar drug in the same class — would work for you.
Alternatives to Mounjaro
Other medications used for type 2 diabetes include:
- Ozempic (semaglutide)
- Trulicity (dulaglutide)
- Victoza (liraglutide)
Always discuss any medication change with your prescribing doctor.
Key facts about Mounjaro on Medicare
- Medicare covers Mounjaro for diabetes, not for weight loss
- Formulary coverage varies by plan more than older diabetes drugs
- Most plans require prior authorization
Frequently asked questions about Mounjaro on Medicare
Does Medicare cover Mounjaro?
Yes, Mounjaro is generally covered by Medicare Part D plans, most often on Tier 3 (preferred brand) or Tier 4. Coverage and costs vary between plans, so compare plans available in your area. Some plans require prior authorization.
How much does Mounjaro cost on Medicare Part D?
Costs typically range from $40 to $500 per month before reaching the $2,100 cap. Your actual cost depends on your plan's deductible, the tier Mounjaro is on, and whether you've reached the $2,100 annual out-of-pocket cap.
Is there a generic version of Mounjaro?
No, there is no generic version of Mounjaro currently available. Patent expirations and FDA approvals will eventually allow generics, but the timing varies. Talk to your doctor about other medications in the same class that may have generic options.
What if my Part D plan doesn't cover this drug?
You have several options: (1) Switch to a different Part D plan during Annual Enrollment that covers Mounjaro, (2) Request a formulary exception from your current plan with your prescriber's support, (3) Ask your doctor about a covered alternative medication, or (4) Look into the manufacturer's Patient Assistance Program if you have limited income.
Compare your Part D options
Coverage and costs for this drug vary significantly between plans. Compare your options:
You can also visit Medicare.gov or call 1-800-MEDICARE