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Diet, Nutrition & Weight Loss
Reply to "Mounjaro prescription without diabetes"
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[quote=Anonymous]Hi OP, I’m on Mounjaro for metabolic syndrome. I do not have diabetes. I have Carefirst with Caremark as my PBM. My provider (PA I see in person here in NOVA) prescribed Mounjaro (MJ) back in September 2022 and I was able to start it due to the original $25 savings card. I was finally able to get coverage for it after my provider submitted a prior authorization (denied) and I submitted an appeal to the denial. I was covered for a full year (2023-2024) and had to do the prior auth/appeal again for year 2 (2024-2025). My appeals were based on my diagnosis of metabolic syndrome. Plus I had to complete step therapy and try metformin, Victoza, Trulicity and Ozempic. I also had to enroll in a free Noom program aimed at diabetes prevention. It’s not impossible but definitely more of a challenge to get covered for Mounjaro as a non-diabetic. Alternatively you can find compounded tirzepatide via Join Mochi or Fridays (both telemedicine) for about $300 a month.[/quote]
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