Mounjaro, the brand name for tripeptide, is an innovative new medication approved by the FDA in 2022 for treating type 2 diabetes. However, it’s also gained attention for its ability to promote weight loss. This has led many people to be interested in trying Mounjaro, even those without diabetes seeking to lose weight.
But there’s a catch – Mounjaro can be very expensive without insurance. A month’s supply can cost over $1,000 out of pocket.
In this comprehensive guide, we’ll break down how much Mounjaro costs with and without insurance. We’ll also provide tips to save money through coupons, patient assistance programs, buying in bulk, and other strategies.
What is Mounjaro?
Mounjaro is a once-weekly injectable prescription medication used to improve blood sugar control in adults with type 2 diabetes. It belongs to a class of drugs called GLP-1 receptor agonists.
Mounjaro works by mimicking natural hormones called incretins. This causes the pancreas to release insulin when blood sugar is high, slows digestion to reduce spikes in blood sugar, and suppresses appetite.
In clinical trials, Mounjaro has been shown to lower A1c, a measure of blood sugar control over time, by up to 2% in adults with type 2 diabetes. It also resulted in average weight loss of up to 22 pounds over 68 weeks.
While not FDA approved for weight loss, Mounjaro is being prescribed off-label by some providers specifically to help patients lose weight.
How Much Does Mounjaro Cost Without Insurance?
The list price for Mounjaro is $1,023.04 for a one month supply, which includes four pens containing doses. However, the out-of-pocket cost people pay at the pharmacy counter can vary.
At most major retail pharmacies, the cash price for Mounjaro ranges from $960 to $1,200 for a 28-day supply without insurance. Some documented prices include:
- Walgreens – $1,177
- CVS – $1,125
- Walmart – $960
- Albertsons – $1,109
This adds up to nearly $13,000 to $15,500 per year if you pay the full retail cost out of pocket. Needless to say, Mounjaro is very expensive without insurance or other coverage.
Does Insurance Cover Mounjaro?
Whether or not insurance covers Mounjaro depends on your specific health plan and prescription drug benefits.
For people with commercial insurance through an employer or purchased individually, Mounjaro is typically covered for diabetes, but not for weight loss alone. You may have to try other medications first.
With insurance for diabetes, you’ll pay a tier 3 or 4 copay, which could range from $40 to over $200 per month depending on your plan. Copays are much lower than retail costs.
For Medicare beneficiaries, coverage can vary. Some Medicare Part D plans cover Mounjaro with prior authorization and step therapy requirements. Others do not include it in their formularies.
Medicaid and CHIP may cover Mounjaro with prior authorization, but coverage varies by state Medicaid program.
If your insurance requires prior authorization, your doctor will need to demonstrate that Mounjaro is medically necessary for you.
How to Get Insurance to Cover Mounjaro
If your insurance doesn’t cover Mounjaro currently, talk to your doctor about requesting an exception or prior authorization.
Here are some tips:
- Have your doctor write a letter of medical necessity explaining why you need Mounjaro over other diabetes or weight loss medications.
- Submit peer-reviewed journal articles and clinical trial data highlighting Mounjaro’s benefits.
- If denied, appeal the decision and provide additional medical evidence.
- Check if the manufacturer provides copay or patient assistance cards you can use even with insurance.
- Ask your doctor to prescribe Mounjaro for an FDA-approved use, like diabetes, if initially prescribed for weight loss.
- Changing to a different insurance plan that covers Mounjaro may be an option as well.
Persistence and a collaborative effort between you and your provider are key to getting insurance coverage for Mounjaro.
6 Ways to Reduce Mounjaro Costs
If you need to pay out-of-pocket for Mounjaro, either short-term or long-term, here are some ways to save:
1. Mounjaro Coupons
The Mounjaro Savings Card offered by manufacturer Eli Lilly can take up to $450 off per 90-day prescription fill. You can get the card online by providing basic information. Using the savings card, you may pay as little as $25 per month.
2. Free Discount Apps
Apps like GoodRx and SingleCare provide free coupons and discounts on Mounjaro. For example, SingleCare offers Mounjaro for around $1,000 instead of $1,200 at Walgreens.
3. Buy in Bulk
You may be able to save by paying for a 3-month supply of Mounjaro instead of getting 1-month fills. This allows you to take advantage of bulk pricing discounts.
4. Alternative Medications
Ask your doctor if medications similar to Mounjaro, like Ozempic or Trulicity, are options that would be covered by your insurance.
5. Switch Pharmacies
Mounjaro costs can vary between pharmacy chains. Check cash prices at multiple pharmacies near you and compare. Independent pharmacies may offer better deals.
6. Patient Assistance Programs
The manufacturer and some external foundations offer financial assistance programs if you meet income eligibility criteria. This provides Mounjaro at no cost if approved.
Using one or a combination of these savings tips can significantly reduce what you pay out of pocket for Mounjaro. Make sure to discuss the options with your healthcare provider.
Mounjaro can be prohibitively expensive without prescription drug coverage, costing over $1,000 out of pocket for a one month’s supply. Exact pricing varies between pharmacies.
Those with commercial insurance through work or private plans may pay much less, around $40 to $200 per month. But prior authorization requirements may still apply.
To reduce costs, take advantage of manufacturer coupons, pharmacy savings apps, buying in bulk, and shopping around pharmacies. Consider using alternatives and discussing options with your doctor to find an affordable treatment plan that meets your health needs.
Frequently Asked Questions
Is there a generic version of Mounjaro?
No, currently there is no generic or biosimilar version of Mounjaro available. The brand name version manufactured by Eli Lilly is the only option. Generic equivalents typically come to market after a drug’s patents expire.
Does Medicare cover Mounjaro?
Original Medicare (Part A and Part B) does not cover prescription medications like Mounjaro. However, Medicare Part D prescription drug plans may include coverage for Mounjaro, usually with prior authorization and step therapy requirements. Mounjaro is not covered by Medicare or Part D plans for weight loss.
Are there any free or low-cost alternatives?
For type 2 diabetes, some alternatives, like metformin and insulin, are available in low-cost generic forms. Ozempic is an injectable drug similar to Mounjaro that costs less, around $850 per month without insurance based on SingleCare data. For weight loss, Contrave and Wegovy are two non-injectable prescription options your doctor may consider.
Can I get a prescription online?
Yes, you can get a prescription for Mounjaro through telehealth platforms and online medical services. They connect you to a healthcare provider who can assess your condition and prescribe Mounjaro, if appropriate. The prescription allows you to purchase it at your local retail pharmacy.
Does SingleCare offer Mounjaro?
Yes, you can get coupons for Mounjaro using the free SingleCare prescription savings app and website. SingleCare provides discounts on Mounjaro at major pharmacies like CVS, Walgreens, Walmart, and Kroger. The discounted price using their coupon is around $1,000 for a month’s supply, based on recent data.
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