Mounjaro Insurance Coverage Update


Tirzepatide (Mounjaro) is a medication approved for the treatment of type 2 diabetes, but it has shown incredible results for weight loss, even for people who do not have diabetes. At Atlanta Endocrine Associates, Dr. Scott Isaacs is a weight loss expert and offers accurate diagnosis and state-of-the-art weight management including Mounjaro. To learn more, contact the office in Atlanta, Georgia.

As with many new medications, insurance coverage can be difficult. For coverage, insurance companies have been requiring that patients have a documented diagnosis of diabetes and have had an inadequate response or intolerable side effects from 3 or 4 other medications. This can create a barrier to filling a prescription for Mounjaro. We hope that soon, tirzepatide will have an official indication for weight loss.

The good news is that the maker of Mounjaro offers a savings card. For patients with type 2 diabetes and commercial drug insurance but no coverage for Mounjaro the saving card may still work. Patients must have commercial drug insurance without Mounjaro coverage and a prescription consistent with FDA-approved product labeling. Unfortunately, the program to pay as little as $25 for 4 pens of Mounjaro is no longer effective but other programs are in place. The terms indicate that you must have a diagnosis of type 2 diabetes to be eligible for the savings card. Semaglutide is marketed under the names Ozempic and Rybelsus for diabetes and Wegovy for weight loss. Mounjaro is a dual incretin or a “twincreatin” that stimulates two satiety hormone receptors: GIP and GLP-1. The average weight loss with tirzepatide is an astonishing 22.5%.

GIP = glucose-dependent insulinotropic polypeptide

GLP-1 = glucagon-like peptide-1

A true comparison between semaglutide and tirzepatide has not been made because in recently released research, a lower 1 mg dose of semaglutide was compared to the highest dose of tirzepatide. Many say this was an unfair comparison and if the full 2.4 mg dose of semaglutide was used the difference may have been smaller or nonexistent. Weight loss numbers in Mounjaro studies are higher than other weight loss medications and are like the results seen with bariatric surgery. Long-acting versions of other GLP-1 medications have been available for over ten years such as liraglutide (Victoza, Saxenda), dulaglutide (Trulicity) or exenatide (Byetta, Bydureon). Until recently, semaglutide was regarded as the latest and the most potent weight loss medication, but tirzepatide appears to generate even more weight loss by its effect on two satiety hormones. Side effects of tirzepatide are like semaglutide, mostly nausea and upset stomach. Most side effects are short-term when the medication is started at the lowest dose and slowly increased over time. There are 6 doses available.

Other weight loss medications include: phentermine (Adipex-P, Lomaira) phendimetrazine (Bontril) benzphetamine (Regimex, Didrex) orlistat (Xenical, alli) phentermine and topiramate ER (Qsymia) Plenity naltrexone HCl and bupropion HCl (CONTRAVE) liraglutide injection (Saxenda) semaglutide injection (wegovy).

The best weight loss results are seen when weight loss medications are combined with intensive lifestyle modification and calorie restriction. The major benefit of weight loss is improvement comorbidities of obesity such as diabetes, high blood pressure, abnormal blood lipids and heart disease which can be seen with as little as 5% weight loss. Remember, tirzepatide or any other weight loss medication is not a magic bullet but simply a tool to lower appetite for sustained calorie reduction. There is no perfect medication for obesity. A medication that may work for a family member or a friend may not be the ideal medication for you. Treating obesity can be complicated so it is best to work with a knowledgeable health care professional who is dedicated to working with you over the long term. If you’d like to learn more about tirzepatide (Mounjaro) or other ways to achieve permanent weight loss, please feel free to call us or schedule an appointment with Dr. Isaacs.