- Do I need a prescription for Mounjaro?
- Can I use Mounjaro to lose weight?
- Does insurance usually cover Mounjaro?
- How much does Mounjaro cost without insurance?
- How much does Mounjaro cost with insurance?
- How to get Mounjaro covered by insurance
- Can you get a coupon for Mounjaro?
- What to do if you cannot afford Mounjaro?
- Are there any cheaper alternative medications?
- 5 ways to save money on Mounjaro
- Conclusion
- Source
Mounjaro is Eli Lilly’s newest brand of tirzepatide.
It is a novel medication approved by the FDA in May 2022 for the treatment of type 2 diabetes mellitus.
It also provides the additional perk of helping in weight loss.
Because Mounjaro is a fairly new drug, many people may have issues with its cost-effectiveness.
Read on to find out more about Mounjaro, its cost, and how to save money on it.
Do I need a prescription for Mounjaro?
Yes. Tirzepatide (Mounjaro) is FDA-approved for the treatment of type 2 diabetes mellitus in adults.
Due to Mounjaro’s ability to cause significant weight loss, many people, including those without diabetes, are tempted to use it to lose weight.
However, Mounjaro remains a prescription medication. It must be prescribed by a doctor after an adequate evaluation of your condition.
Not only that, but your doctor should also monitor for side effects and how well your body is responding to the medication.
Some of the most common side effects from Mounjaro use are nausea, vomiting, diarrhea, constipation, indigestion, and stomach pain.
Other adverse effects include acute pancreatitis (inflammation of your pancreas), gallbladder diseases, and an allergic reaction to the drug.
Your doctor should monitor your body weight and HbA1c level during your subsequent clinic appointments.
HbA1C level monitoring can be done as frequently as once every three months. Monitoring is further indicated if your doctor increases your Mounjaro dose.
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Can I use Mounjaro to lose weight?
Though it is undeniable that Mounjaro can cause weight loss, it is currently not approved to treat obesity.
However, some doctors may use Mounjaro injections as an off-label medication to treat adults who are:
- Overweight: having a BMI of 27 or more
- Obese: having a BMI of 30 or more
It is important to note that the treatment of obesity involves multidisciplinary care that includes your obesity physician, bariatric surgeon, dietitian, psychologist, and anesthetist.
Because off-label drugs like semaglutide and tirzepatide are gaining traction in weight loss clinics, it can lead to a shortage of these medications for patients who actually need them.
If you have questions about Mounjaro for weight loss, you should consult your doctor.
Does insurance usually cover Mounjaro?
Yes. If you’re taking Mounjaro for type 2 diabetes, your insurance company is more likely to cover the medication.
Because Mounjaro is not approved to treat weight loss, insurance is unlikely to cover the cost of Mounjaro if you do not have diabetes.
You can also contact your insurance company to inquire if Mounjaro is on their formulary and ask which conditions it covers it for.
How much does Mounjaro cost without insurance?
The cost of Mounjaro varies depending on your treatment plan, your location, and the pharmacy you are buying from. The list price of Mounjaro is $1,023.04 per fill, and it can be around $1,585.51 out-of-pocket if you do not have insurance coverage.
The table below shows the retail price of Mounjaro at different pharmacies:
| Pharmacy | Retail Price |
| Walgreens | $1198.61 per month |
| Kroger | $1202.35 per month |
| Albertsons | $1109.51 per month |
| CVS Pharmacy | $1180.69 per month |
| Rite Aid | $1321.27 per month |
| Walmart | $1209.49 per month |
How much does Mounjaro cost with insurance?
The amount that you will pay depends on your current prescription medication insurance plan. However, the information on specific insurance plan pricing is still unavailable because Mounjaro is a relatively new medicine.
How to get Mounjaro covered by insurance
With Mounjaro costing over $12,000 a year without insurance coverage, it is no surprise that many people want to get Mounjaro covered by their insurance.
If your prescription is denied by your insurance, you can ask your doctor to help by appealing the decision.
Many insurance plans require a Letter of Medical Necessity (LMN) and a coverage authorization appeal letter if you are appealing the decision.
You should also show your doctor any insurance denial letters so that their office does not request or appeal using the previously denied reason.
It is important to provide the correct information to minimize any delays in treatment.
If your insurance comes through your employer, you can approach the human resources (HR) department for help.
It is possible that your company has informed the insurance company what they will and will not cover, and the HR department can try to appeal for Mounjaro to be covered.
Can you get a coupon for Mounjaro?
Yes. With the Mounjaro Savings Card Program, eligible commercially insured patients with Mounjaro coverage can pay as little as $25 a month.
To qualify for the Mounjaro Savings Card Program, you need to be a resident of the United States or Puerto Rico aged 18 years or older with a prescription for Mounjaro to treat type 2 diabetes.
You also must not be enrolled in a federal or state government-funded prescription program.
Keep in mind that this program expires on 31 December 2023 for up to 12 pens, or whichever comes first.
If you do not have commercial drug insurance coverage for Mounjaro, but you have a prescription for Mounjaro to treat type 2 diabetes, you can save up to $575 off your 1-month prescription fill of Mounjaro via the Mounjaro Savings Card Program.
You can save up to $575 a month and a maximum of $3,450 per calendar year.
Keep in mind that this program expires on 31 December 2023 for up to 4 pens, or whichever comes first.
With SingleCare or GoodRx, you can get coupons to help you get Mounjaro at a lower price:
| Participating pharmacy | Retail price | Price with SingleCare coupons | Price with GoodRx coupons |
| Walgreens | $1198.61 | $995.35 | $1064 |
| Kroger | $1227.00 | $1036 | $1227 |
| Albertsons | $1109.51 | $1036 | – |
| CVS Pharmacy | $1180.69 | $1038 | $1057 |
| Rite Aid | $1321.27 | $1059.78 | $1000 |
| Walmart | $1209.49 | $1077 | $1068 |
| Costco | $1249 | – | $1136 |
| Publix | $1280 | – | $1013 |
| Wegmans | $1360.00 | – | $991.83 |
What to do if you cannot afford Mounjaro?
You can consider enrolling in patient assistance programs (PAPs). These are usually sponsored by pharmaceutical companies.
They offer cost-free or discounted medicines and copay programs to people from lower socioeconomic backgrounds or those who are uninsured or underinsured. To qualify for PAPs, you need to meet specific criteria.
You can use the Medical Assistance Tool to find out more about assistance programs for Mounjaro as well as for other drugs. This tool is created by the drug industry’s trade association PhRMA.
Alternatively, you can consult your doctor to ask for cheaper options to treat your diabetes.
Are there any cheaper alternative medications?
Newer drugs tend to cost more compared to older drugs which are available in generic forms. These drugs can also help to regulate blood sugar if you have type 2 diabetes.
However, they may not be as effective in causing weight loss, especially rapid weight loss. You may discuss other cheaper alternative medications with your healthcare provider.
Here are some options to consider if you are looking to control your blood glucose:
- Metformin or Metformin XR
- Dulaglutide
- Glyburide
- Glucotrol
- Glimepiride
- Acarbose
- Rosiglitazone
- Pioglitazone
5 ways to save money on Mounjaro
Until Mounjaro is available as a generic version, it remains a brand-name medication and may be a burden to sustain due to its high cost.
Here are some ways you can save money on Mounjaro:
1) Look out for savings coupons
Sites such as SingleCare and GoodRx can offer free coupons to help you save on Mounjaro prescriptions in participating pharmacies. These coupons may vary depending on the quantity, strength of your prescription, and the pharmacy.
2) Sign up for the Mounjaro Savings Card Program
Mounjaro’s manufacturer, Eli Lilly, is currently offering the Mounjaro Savings Card Program. This program can help you save on your Mounjaro prescription if you are eligible.
3) Compare prices at multiple pharmacies
Every pharmacy may offer different prices for Mounjaro. You can compare the prices of Mounjaro in multiple pharmacies to ensure that you are getting the lowest price. There are websites such as SingleCare, GoodRx, and Pharmacy Checker.
4) Check your prescription coverage plan
You can keep up to date with your insurance provider on their prescription coverage. While most insurance plans do not cover Mounjaro prices yet, they may change at any time.
Be sure to compare the formulary of several plans during your next open enrollment period to ensure you choose the plan best suited for your specific needs.
5) Switch to a cheaper medication
Generic medications usually cost less and are covered by your insurance plan. You can discuss other lower-cost alternatives with your doctor. Generic drugs can be as effective and are more cost-effective.
Conclusion
Mounjaro (tirzepatide) is a prescription medication that is approved by the FDA to treat adults with type 2 diabetes mellitus.
However, it is not a magical drug as it is meant to be used synergistically with exercise and a healthy diet to improve blood sugar levels.
Since it is still new to the market, Mounjaro may or may not be covered by your insurance. Mounjaro can cost $50,000 or more a year without insurance coverage.
There are several ways to save money on Mounjaro, including saving coupons, the Mounjaro Savings Card Program, comparing prices at multiple pharmacies, checking your prescription plan, checking your prescription coverage, and switching to a cheaper alternative.
You can consult your doctor to find out more about other medications to treat your diabetes.
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