The facts
Weight loss
Generally no
Type 2 diabetes
Yes, with PA
Prior auth
Typical
Typical cost
Part D tier copay
The criteria, as published
1 of 9 criteria are stated in the Humana documents we read. Tap a row for the exact wording. Where a cell says not published, the documents we read do not say, and the line under it is how to find out.
- Formulary status
- Not published in what we readLook Mounjaro up in your plan's drug list or price tool, or call the number on your card.
- BMI threshold
- Not published in what we readAsk member services for the written prior authorization criteria for Mounjaro.
- Qualifying conditions
- Not published in what we readAsk which conditions the Mounjaro criteria accept alongside BMI.
- Lifestyle program
- Not published in what we readAsk whether a diet, exercise or behavioral program has to be documented, and for how long.
- Step therapy
- Not published in what we readAsk whether another drug has to be tried before Mounjaro.
- Quantity limit
- Not published in what we readAsk what quantity limit applies to each fill.
- Renewal
- Not published in what we readAsk how long an approval lasts and what the renewal needs.
- Plan can exclude it?
Yes: Medicare Part D does not cover drugs used only for weight loss
“Medicare Part D doesn't cover weight loss medications when used only for weight loss. ... Part D may cover drugs like Ozempic and Wegovy if they're prescribed for diabetes management or cardiovascular disease.”
humana.com · 2026-08-28- 2026 change
- Not published in what we readAsk whether Mounjaro's status changed this year or changes at your next renewal.
Who actually decides this
Not the logo on your card, most of the time. Three parties sit between you and the answer, and knowing which one is saying no tells you who to ask.
- 1
The pharmacy benefit manager
No single PBM to name here, which is itself the finding. Different plans under this name use different benefit managers, so one national statement about the formulary would be wrong.
- 2
Your employer, if the plan comes through work
Weight-loss drugs are usually a category an employer buys or declines, not something the insurer includes by default. That is why two people holding identical cards get opposite answers, and why the useful question for member services is whether your plan includes the weight-loss medication benefit at all, before anything about criteria.
How prior authorization works here
Six steps. Specifics come from the criteria above; where Humana does not publish one, the step says what to ask for.
- 1
Confirm the benefit exists
Before any paperwork, ask whether your plan includes the weight-loss drug benefit. On whether a plan can leave it out, the documents say: Yes: Medicare Part D does not cover drugs used only for weight loss.
- 2
Get the criteria in writing
Ask for the written prior authorization criteria for Mounjaro, so your prescriber answers the plan's questions rather than guessing at them.
- 3
Your prescriber documents the clinical picture
Current and baseline BMI, with dates. Any weight-related conditions, with diagnosis codes. Records of any diet, exercise or behavioral program.
- 4
Answer step therapy, if there is any
Ask whether another drug must come first. If you have already tried one, the request should list it with dates and the reason it stopped.
- 5
Submit, then track it
Your prescriber sends the plan’s form with the notes. Write down the date and the reference number, and ask how you will hear back.
- 6
Plan for the renewal
Ask how long the approval lasts and what the renewal needs, so the gap does not catch you out.
Get your real answer
Check Mounjaro's tier in your own Humana plan's formulary and have the diabetes diagnosis documented for prior authorisation. If you are seeking it for weight, ask about the Zepbound KwikPen through the Medicare GLP-1 Bridge instead, since that is the covered path for the same active ingredient.
Coverage is plan-specific: this page reports what Humana publishes, not a promise about your plan. Not medical or insurance advice.
