Coverage at a glance
| Indication | Coverage |
|---|---|
| Type 2 diabetes | Covered with prior authorization |
Plan type: Commercial non-Medicare. Each indication below lists the BMI and clinical thresholds, the prior-authorization documentation, and the published policy it comes from.
This varies by plan. Self-funded employer plans choose their own drug list and can add step therapy or exclude GLP-1 drugs. Check your plan's formulary to confirm tier and rules.
Coverage by indication
What the prior authorization needs:
- Prior authorization required before the plan covers it.
- Quantity limit applies.
- Placed on Tier 2 (higher cost share than Tier 1).
Source: Anthem 2025 Select Drug List (Four Tier), Maine, effective 12/01/2025. formulary. Verified August 27, 2026. This row is marked lower confidence: the policy document was confirmed at its public URL but served as an unreadable file, so the policy number and framework were cross-checked against secondary sources.
What to do next
If you qualify under one of the covered indications above, prior authorization is the path. Match the documentation in the requirements list then have your prescriber submit it. Plans that approve reassess at renewal, so know your long-term maintenance dose before you start.
- Browse the prior-authorization letter library for a template that matches your plan and indication.
- Read the full coverage picture, denial reasons, and the four appeal pathways at GLP-1 insurance coverage.
- If the prior-authorization request is denied, the appeal letter library has templates by denial reason, covering peer-to-peer review, Level 1 and Level 2 internal appeal, and external review.
- Call the number on your insurance card and ask whether your specific plan includes the weight-management drug benefit before you submit.
- If your plan does not cover the indication you need, compare cash prices in the cost guide or check whether a clinical trial near you fits. Neither one goes through your insurer. Clinical trials cost nothing and many pay you for your time. Some participants get a placebo, decided at random.
What it costs without insurance
The programs below bill you directly. Prices checked every Monday.
Frequently asked questions
Does Anthem cover Mounjaro?
Anthem covers Mounjaro for type 2 diabetes, but the plan requires prior authorization first and applies a quantity limit. On one 2025 Anthem drug list the medicine sits on Tier 2, a higher cost share than a generic, but the tier varies by employer plan. Anthem will not cover Mounjaro for weight loss, because Mounjaro is FDA-approved only for type 2 diabetes. The weight-loss version of the same drug, tirzepatide, is Zepbound, which Anthem reviews under a separate weight-loss policy. This reflects the published policy verified August 2026.
What does Anthem require to approve Mounjaro?
For type 2 diabetes: Prior authorization is required, with the documentation listed in the requirements above.
Why might Anthem deny Mounjaro even if I meet the criteria?
Self-funded employer plans choose their own drug list and can add step therapy or exclude GLP-1 drugs. Check your plan's formulary to confirm tier and rules.
Coverage for other payers
See the full payer coverage index for every plan we have sourced.
How we built this page
Each page is built from a published payer policy document, government statute, or independent formulary analysis (KFF). Every indication row carries the source URL and the date we verified it. Where a payer's policy PDF was confirmed at its public URL but served as an unreadable binary, the policy number and coverage framework were cross-checked against secondary sources; those rows are marked lower confidence. Commercial coverage often depends on whether an employer elected the weight-management benefit. Those rows say varies by plan rather than a flat yes.
This is reference information, not medical or legal advice, and not a guarantee of coverage. GLP-1 coverage policies change often. Always confirm the current policy with your insurer using the number on your card before you rely on this page. If your experience differs from what is shown here, email hello@glpchart.com with the details and we will re-verify.
