{"id":7907,"date":"2025-07-26T02:00:07","date_gmt":"2025-07-26T02:00:07","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/hmn-does-blue-cross-blue-shield-cover-mounjaro-in-2025\/"},"modified":"2025-07-26T02:00:07","modified_gmt":"2025-07-26T02:00:07","slug":"hmn-does-blue-cross-blue-shield-cover-mounjaro-in-2025","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-does-blue-cross-blue-shield-cover-mounjaro-in-2025\/","title":{"rendered":"HMN: Does Blue Cross Blue Shield cover Mounjaro? in 2025"},"content":{"rendered":"<p>\n<br \/>Do you know:  Does Blue Cross Blue Shield cover Mounjaro? in 2025<\/p>\n<div id=\"main-content\">\n<div id=\"post-intro\">\n<div id=\"takeaways\">\n<h2>Key takeaways<\/h2>\n<ul>\n<li>\n<p><span style=\"font-weight: 400;\">Some Blue Cross Blue Shield (BCBS) plans cover Mounjaro for Type 2 diabetes, but they typically require prior authorization.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">Without insurance or other discounts, Mounjaro costs about $1,486 per 4, 0.5 mL of 5 mg\/0.5 mL pens.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">There are ways to save on Mounjaro if it isn\u2019t on your BCBS prescription drug formulary.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<section class=\"table-of-contents\">\n<div class=\"anchorLinks\">\n<div class=\"mobile-only\">\n<div class=\"dropdownLists\">\n<div tabindex=\"0\" class=\"dropdownBtn\"><span class=\"listsIcon\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/union.svg\" width=\"14\" height=\"20\"\/><\/span><br \/>\n\t\t\t\t\t\t\t<label><\/label><br \/>\n\t\t\t\t\t\t\t<span class=\"downArrow\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/dropDownArrow.svg\" width=\"24\" height=\"24\"\/><br \/>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<p><span style=\"font-weight: 400;\">Mounjaro (tirzepatide) is a brand-name prescription medication that\u2019s approved by the Food and Drug Administration (FDA) to lower blood sugar levels in people with Type 2 diabetes. Manufactured by Lilly, Mounjaro is a once-weekly injection available in <\/span><span style=\"font-weight: 400;\">six different doses<\/span><span style=\"font-weight: 400;\">. It\u2019s considered a glucose-dependent insulinotropic polypeptide (GIP) agonist\/glucagon-like peptide-1 (<\/span><span style=\"font-weight: 400;\">GLP-1<\/span><span style=\"font-weight: 400;\">) receptor agonist. Some health insurance formularies cover Mounjaro, while others list it as a nonpreferred drug.\u00a0<\/span><\/p>\n<h2 id=\"does-blue-cross-blue-shield-cover-mounjaro\"><span style=\"font-weight: 400;\">Does Blue Cross Blue Shield cover Mounjaro?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Blue Cross Blue Shield (BCBS) coverage of Mounjaro varies by plan and the BCBS affiliate (like Anthem) selling the plan. For example, <\/span><a href=\"https:\/\/client.formularynavigator.com\/Search.aspx?siteCode=0810534435&amp;targetScreen=3&amp;drugBrandListBaseKey=mounjaro%2Bsubcutaneous%2Bsolution%2Bauto-injector%2B10%2Bmg%252f0.5ml&amp;drugId=229076\"><span style=\"font-weight: 400;\">Anthem Blue Cross Blue Shield (Upstate New York)<\/span><\/a><span style=\"font-weight: 400;\"> covers Mounjaro in most plans. <\/span><a href=\"https:\/\/fm.formularynavigator.com\/FBO\/251\/Excellus_2024_Exchange_Formulary_2981_v25.pdf\"><span style=\"font-weight: 400;\">Excellus Blue Cross Blue Shield<\/span><\/a><span style=\"font-weight: 400;\"> does as well. Both list Mounjaro as a tier 2 drug with quantity limits and prior authorization required.<\/span><\/p>\n<h3 id=\"bcbs-medicare-and-medicaid-plans\"><span style=\"font-weight: 400;\">BCBS Medicare and Medicaid plans<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Medicare<\/span><span style=\"font-weight: 400;\"> and <\/span><span style=\"font-weight: 400;\">Medicaid<\/span><span style=\"font-weight: 400;\"> coverage for Mounjaro may be different than coverage offered by private or employer-sponsored plans. For example, although Excellus Blue Cross Blue Shield covers Mounjaro in some individual and family plans, it <\/span><a href=\"https:\/\/medicare.excellusbcbs.com\/prescriptions\/drug-lists\"><span style=\"font-weight: 400;\">does not cover Mounjaro in its Medicare plans<\/span><\/a><span style=\"font-weight: 400;\">. In contrast, <\/span><a href=\"https:\/\/www.bcbsm.com\/medicare\/resources\/forms-documents\/drug-lists\/\"><span style=\"font-weight: 400;\">Blue Cross Blue Shield of Michigan<\/span><\/a><span style=\"font-weight: 400;\"> covers Mounjaro in all Medicare plans.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicaid coverage varies by state. For example, <\/span><a href=\"https:\/\/www.bcbsil.com\/medicaid\/pdf\/bcchp-drug-list-il.pdf\"><span style=\"font-weight: 400;\">Blue Cross Blue Shield of Illinois<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.mibluecrosscomplete.com\/amslibs\/content\/dam\/microsites\/blue-cross-complete\/preferred-drug-list.pdf\"><span style=\"font-weight: 400;\">Blue Cross Complete of Michigan<\/span><\/a><span style=\"font-weight: 400;\"> do list Mounjaro as a non-preferred drug but require prior authorization.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Even if your BCBS health plan covers Mounjaro, you may need to get <\/span><span style=\"font-weight: 400;\">prior authorization<\/span><span style=\"font-weight: 400;\"> from the insurance company to confirm they\u2019ll pay for it. \u201cInsurance companies seem less and less likely to cover medications like Mounjaro due to their cost,\u201d says <\/span><a href=\"https:\/\/sanctuarywellnessinstitute.com\/reviewer\/dr-megan-horsham.php\"><span style=\"font-weight: 400;\">Megan Horsham<\/span><\/a><span style=\"font-weight: 400;\">, a board-certified physician who specializes in weight loss at The Sanctuary Wellness Institute. \u201cIf you do not fit BMI criteria or do not have Type 2 diabetes, your insurance might not cover them.\u201d<\/span><\/p>\n<h2 id=\"does-blue-cross-blue-shield-cover-mounjaro-for-weight-loss\"><span style=\"font-weight: 400;\">Does Blue Cross Blue Shield cover Mounjaro for weight loss?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Blue Cross Blue Shield doesn\u2019t typically cover Mounjaro for weight loss because it\u2019s considered an <\/span><span style=\"font-weight: 400;\">off-label<\/span><span style=\"font-weight: 400;\"> use of the drug. However, tirzepatide, the active ingredient in Mounjaro, is an FDA-approved weight loss medication under the brand name <\/span><span style=\"font-weight: 400;\">Zepbound<\/span><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Because insurance companies tend to only cover prescriptions for their FDA-approved use, Blue Cross Blue Shield is more likely to cover Zepbound than Mounjaro for weight loss or sleep apnea, a recently FDA-approved use for Zepbound. That being said, coverage for weight loss drugs is sometimes limited unless the patient has a comorbid condition, like <\/span><span style=\"font-weight: 400;\">sleep apnea<\/span><span style=\"font-weight: 400;\">, high blood pressure, or high cholesterol.<\/span><\/p>\n<p><b> <\/b><b>Zepbound vs. Mounjaro<\/b><\/p>\n<h2 id=\"does-blue-cross-blue-shield-cover-tirzepatide\"><span style=\"font-weight: 400;\">Does Blue Cross Blue Shield cover tirzepatide?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Tirzepatide, the active ingredient in Mounjaro, <\/span><span style=\"font-weight: 400;\">isn\u2019t available as a generic medication<\/span><span style=\"font-weight: 400;\">, so it isn\u2019t covered by Blue Cross Blue Shield.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some specialty pharmacies will create their own version of Mounjaro, known as <\/span><span style=\"font-weight: 400;\">compounded tirzepatide<\/span><span style=\"font-weight: 400;\">. Compounded drugs aren\u2019t usually covered by insurance because they aren\u2019t FDA approved, and the FDA has shared its <\/span><span style=\"font-weight: 400;\">concerns about compounded GLP-1s<\/span><span style=\"font-weight: 400;\"> like Mounjaro, such as low-quality ingredients, contaminants, or incorrect dosing. Furthermore, now that the shortage is over, <\/span><a href=\"https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-clarifies-policies-compounders-national-glp-1-supply-begins-stabilize\"><span style=\"font-weight: 400;\">the FDA may take action against compounding pharmacies<\/span><\/a><span style=\"font-weight: 400;\"> that compound, distribute, or dispense compounded GLP-1s.<\/span><\/p>\n<h2 id=\"how-much-does-mounjaro-cost\"><span style=\"font-weight: 400;\">How much does Mounjaro cost?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Without insurance, Mounjaro costs an average of $1,486 per 4, 0.5 mL of 5 mg\/0.5 mL pens. With a <\/span><span style=\"font-weight: 400;\">Mounjaro coupon from <\/span><span style=\"font-weight: 400;\">, you could pay as low as $869 instead, depending on your pharmacy and location.<\/span><\/p>\n<h2 id=\"how-much-does-mounjaro-cost-with-blue-cross-blue-shield\"><span style=\"font-weight: 400;\">How much does Mounjaro cost with Blue Cross Blue Shield?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The cost of Mounjaro with Blue Cross Blue Shield health insurance varies by plan. Plans typically structure their prescription costs in one of three ways:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Fixed copays\u2014including $0 copays\u2014for all prescription medications, with lower copays for generic drugs and higher copays for name-brand prescription drugs like Mounjaro\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Coinsurance, which means you pay a percentage of the total cost of the prescription, with higher percentages reserved for name-brand prescriptions\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Full out-of-pocket cost for all prescriptions until the plan\u2019s deductible is met<\/span><\/li>\n<\/ul>\n<h2 id=\"how-to-check-whether-your-blue-cross-blue-shield-plan-covers-mounjaro\"><span style=\"font-weight: 400;\">How to check whether your Blue Cross Blue Shield plan covers Mounjaro\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">To find out if your Blue Cross Blue Shield plan covers Mounjaro, call the customer service number on the back of your insurance card or ask your pharmacist for assistance.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You can also log in to your health insurance portal to access policy documents. The two you want to look for are the drug list (also called a formulary, pharmacy benefits document, or PDL) and the summary of benefits.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Look for Mounjaro on the list of drugs. If it\u2019s labeled as a \u201cnonpreferred\u201d drug, your plan is more likely to cover an alternate medication for Type 2 diabetes, but it may cover Mounjaro if your doctor advocates for insurance coverage on your behalf. If Mounjaro is listed as a preferred drug, it\u2019s more likely to be covered with fewer restrictions.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some drug coverage lists also assign a tier level to each prescription. Lower tier drugs tend to have cheaper copays than higher tier drugs. Check the document glossary to understand the meaning of each tier.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Once you know the tier level of Mounjaro, check the summary of benefits document to see how much you pay for drugs in that tier.\u00a0<\/span><\/p>\n<h2 id=\"how-to-save-on-mounjaro\"><span style=\"font-weight: 400;\">How to save on Mounjaro<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If your Blue Cross Blue Shield health insurance plan doesn\u2019t cover Mounjaro, you can save money with a free <\/span><span style=\"font-weight: 400;\"> prescription discount card<\/span><span style=\"font-weight: 400;\">. Signing up is easy, and it provides access to instant coupons you can use at most pharmacies. Just find your preferred pharmacy on the <\/span><span style=\"font-weight: 400;\">Mounjaro coupon page<\/span><span style=\"font-weight: 400;\"> at .com, and select the corresponding \u201cget free coupon\u201d button. Save this coupon by printing it or sending yourself a digital copy via text or email. When you\u2019re ready to pick up your Mounjaro prescription, show the pharmacist the coupon. You can also use the  app to find coupons.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are other <\/span><span style=\"font-weight: 400;\">ways to save money on Mounjaro<\/span><span style=\"font-weight: 400;\"> as well. You can also talk to your healthcare provider about <\/span><span style=\"font-weight: 400;\">Mounjaro alternatives<\/span><span style=\"font-weight: 400;\"> that may be more affordable, depending on your insurance, such as <\/span><span style=\"font-weight: 400;\">Ozempic<\/span><span style=\"font-weight: 400;\"> (semaglutide) or <\/span><span style=\"font-weight: 400;\">Victoza<\/span><span style=\"font-weight: 400;\"> (liraglutide).<\/span><\/p>\n<p><svg style=\"display:none\">\n  <g id=\"facebook\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M19.51 9.32003H21.39V6.14003C20.4798 6.04538 19.5652 5.99865 18.65 6.00003C15.93 6.00003 14.07 7.66003 14.07 10.7V13.32H11V16.88H14.07V26H17.75V16.88H20.81L21.27 13.32H17.75V11.05C17.75 10 18.03 9.32003 19.51 9.32003Z\"\/>\n  <\/g>\n  <g id=\"twitter\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" 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Without insurance or other discounts, Mounjaro costs about $1,486 per 4, 0.5 mL of 5 mg\/0.5 mL pens. There are ways to [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7907","post","type-post","status-publish","format-standard","hentry","category-health-news"],"blocksy_meta":[],"_links":{"self":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/7907","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/comments?post=7907"}],"version-history":[{"count":0,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/7907\/revisions"}],"wp:attachment":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/media?parent=7907"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/categories?post=7907"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/tags?post=7907"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}