How Much Is Mounjaro?

Projections show that by 2060, about 526,000 young people are expected to have type 1 or type 2 diabetes. Managing it is essential, but the cost can be a major burden. In the US, diabetes care reached $412.9 billion in 2022, with most of that from direct medical expenses.

Mounjaro (tirzepatide) is an effective type 2 diabetes treatment, but it’s expensive. Without financial help, many people can’t afford it, leading to skipped doses or stopping treatment.

This guide explains how much Mounjaro costs with and without insurance, and what you can do to reduce your costs by understanding and using your insurance options.

How Much Is Mounjaro Out Of Pocket?

Mounjaro’s official list price is $1,079.77 per fill, but in retail, you’ll usually see it selling between $1,000 and $1,200, depending on the pharmacy. Over a year, that can easily top $12,800, making it a big expense if you’re paying out of pocket.

Factors That Influence Your Mounjaro Cost

Several factors impact how much Mounjaro is without insurance:

How To Get Mounjaro Without Insurance

Pharma Giant offers a more affordable way and a convenient solution for you. We make it easy to get Mounjaro delivered straight to your door, and at a lower price than many US pharmacies. As a licensed Canadian pharmacy partner, we’re committed to providing safe and affordable access to medications.

In Canada, Mounjaro is supplied in two formats:

1. Mounjaro KwikPen (newer format)

A multi-dose, single-patient-use, prefilled pen. Each pen contains four full weekly doses, meaning one pen lasts an entire month, similar to how the Ozempic pen works. Just like the Mounjaro pen in the US, the Mounjaro KwikPen is also available in 6 dose strengths (2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, or 15 mg).

Here’s a look at the pricing and savings with Mounjaro Kwikpens from Pharma Giant:

2. Mounjaro Vials (until supplies last)

It’s a single-dose vial, meaning each vial contains one full dose, so you’ll need four vials for a month. The Mounjaro vial is also available in 6 dose strengths. However, availability is limited to the remaining inventory in the market as more patients move to the newer KwikPen format.

Here’s a look at the pricing and savings with Mounjaro vials from Pharma Giant:

You can save even more with our Mounjaro coupons (great for those without insurance), bulk orders, and as a new customer, you’ll get an extra 10% off with the code PGSAVE10.

How to place your order:

Does Insurance Cover Mounjaro?

Yes, many US insurance plans cover Mounjaro when it’s prescribed for type 2 diabetes. However, plans almost always require prior authorization (PA), and the exact rules vary by insurer and program.

How coverage works:

• • What insurers look for: Proof you have type 2 diabetes (diagnosis and lab values), that the prescription is for diabetes (not weight loss), and sometimes that you’ve tried other diabetes meds first (for example, metformin). Approvals are commonly issued for 12 months at a time.

• • What they won’t cover: Using Mounjaro for polycystic ovary syndrome (PCOS), weight loss, prediabetes/diabetes prevention, type 1 diabetes, or metabolic syndrome.

What prior authorization (PA) usually asks for:

• • Diagnosis proof of type 2 diabetes, example:

• • • • an A1C greater than or equal to 6.5%
      • a fasting plasma glucose (FPG) greater than or equal to 126 mg/dL
      • a 2-hour plasma glucose (PG) greater than or equal to 200 mg/dL during oral glucose tolerance test (OGTT)
      • random PG greater than or equal to 200 mg/dL with symptoms of hyperglycemia (e.g., polyuria, polydipsia, polyphagia)

• • Treatment history, sometimes including inadequate treatment response, intolerance, or a contraindication to preferred GLP-1 agents, like Ozempic and liraglutide, with documentation.

• • Attestation it’s for diabetes, not weight loss (insurers flag this specifically).

• • Renewal typically after ~12 months, often with updated A1c/clinical status.

Disclaimer: The information in this article reflects insurance coverage policies as of the time of writing. Because insurance rules and formularies can change at any time, confirm the most current requirements and coverage details directly with your insurance provider before making any decisions.

Commercial Insurance (Employer & ACA Marketplace)

Below are examples from major payers to show what “typical” coverage for Mounjaro looks like. Your own plan’s pharmacy benefit manager (PBM) may be OptumRx, CVS Caremark, or Express Scripts. Each sets the PA rules your plan adopts.

Public Health Insurance Programs

The government sets up and oversees these programs to ensure health coverage for particular populations, including:

1. Medicare (Part D & Medicare Advantage drug coverage)

Part D plans can cover Mounjaro for its approved indication (type 2 diabetes) if it’s on the plan’s formulary, often with PA. By law, Part D excludes drugs “when used for weight loss.” If your Part D plan covers Mounjaro and you meet PA, your total yearly spending on all Part D drugs won’t exceed $2,000 in 2025.

2. Medicaid (state programs)

Most states cover Mounjaro for type 2 diabetes with PA and step therapy. For example, Aetna Better Health (Medicaid) requires documented proof of diagnosis and either prior treatment failure with metformin or preferred GLP-1 drugs (Ozempic or liraglutide), or a high A1c level. Exact rules vary by state plan.

3. TRICARE, VA & CHAMPVA (military/veterans)

These programs are established specifically to provide health coverage to military personnel and their families:

Helpful tip!

To prevent delays, be aware of the most common denial reasons and how to address them:

• • No lab documentation of diabetes: Ask your clinic to include recent A1c/glucose values.

• • Off-label weight-loss request: Plans will deny this most of the time. If weight loss is the intent and your plan covers anti-obesity meds, your prescriber should pursue Zepbound criteria instead.

• • Step therapy not met (e.g., no metformin trial): Document intolerance/contraindication or prior use.

• • Duplicate therapy (using two GLP-1s together): Most plans prohibit this. Ensure only one agent is on the med list.

How Much Is Mounjaro With Insurance?

With insurance, your cost for Mounjaro will vary based on your plan. Here’s a general estimate:

Commercial insurance

If your plan covers Mounjaro, Lilly’s Mounjaro Savings Card can drop your price for as little as $25 per 28-, 56-, or 84-day fill. However, the card only pays up to a yearly maximum of $1,950. If your plan doesn’t cover Mounjaro (but you still have commercial insurance), the same card can take up to $463 off each 28-day fill (yearly max $6,019). Government program members aren’t eligible.

Medicare

With Part D, your total annual out-of-pocket spending on all covered drugs can’t exceed $2,000, and you generally pay 25% coinsurance. Plans can set different copays/coinsurance, but 25% is the federal standard. After you hit $2,000, you pay $0 for covered drugs for the rest of the year.

Medicaid

The exact charges and amounts depend on your state and your income. For regular Medicaid cost-sharing, amounts are usually “nominal”, and providers can’t refuse care if you don’t pay, though you may still owe the money.

States can also set alternative cost-sharing rules for people with incomes above the federal poverty level. These can be higher than nominal charges (within limits) and can be up to 5% of family income. Under these alternative rules, services can be denied for nonpayment.

TRICARE

Your pharmacy copay depends on where you fill:

Veterans Affairs

Mounjaro is not on the VA National Formulary, requiring a non-formulary approval. If approved, VA’s 2025 copays per 30-day supply are:

• • $5 (Tier 1)
  • $8 (Tier 2)
  • $11 (Tier 3)

With a $700 annual cap, though some Vets are exempt. A brand-only drug like Mounjaro typically falls into the higher tier.

CHAMPVA

CHAMPVA has a small annual deductible of $50 per individual and $100 per family, and uses OptumRx for network fills. Your pharmacy cost share depends on the network and dispensing channel.

Summary

Mounjaro can be a significant out-of-pocket expense in the US, with retail prices often exceeding $1,000 per month and annual costs topping $12,800 without insurance. While many commercial, Medicare, Medicaid, and military insurance plans cover Mounjaro, nearly all require prior authorization and step therapy, which can delay treatment.

If you’re looking to lower your costs, buying through a licensed Canadian pharmacy partner like Pharma Giant can cut monthly costs by hundreds, or even over $2,000 for a three-month supply, compared to US retail prices.

Frequently Asked Questions