What To Know
- This blog post aims to provide a comprehensive guide on whether Passport, a Medicare Part D prescription drug plan, covers Mounjaro and the associated costs.
- Passport may place Mounjaro in a specific tier, which can impact the cost of the medication.
- If Passport does not cover Mounjaro or if the coverage is limited, you may explore alternative coverage options.
Mounjaro, a once-weekly injectable medication, has gained significant attention for its potential in treating obesity and type 2 diabetes. However, navigating insurance coverage for Mounjaro can be confusing. This blog post aims to provide a comprehensive guide on whether Passport, a Medicare Part D prescription drug plan, covers Mounjaro and the associated costs.
What is Mounjaro?
Mounjaro (tirzepatide) is a glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. It works by increasing insulin secretion, suppressing glucagon secretion, and slowing gastric emptying, resulting in weight loss and improved blood sugar control.
Does Passport Cover Mounjaro?
Yes, Passport covers Mounjaro. However, coverage may vary depending on the specific plan and formulary. It’s essential to check with your individual Passport plan to confirm coverage and any applicable restrictions.
Coverage Restrictions and Limitations
While Passport covers Mounjaro, there may be certain restrictions or limitations to consider:
- Prior Authorization: Some plans may require prior authorization before approving coverage for Mounjaro. This process involves obtaining approval from the insurance company before the medication can be dispensed.
- Tier Placement: Passport may place Mounjaro in a specific tier, which can impact the cost of the medication. Higher-tier medications typically have higher out-of-pocket costs.
- Quantity Limits: Some plans may limit the quantity or frequency of Mounjaro prescriptions that are covered.
Costs of Mounjaro with Passport
The cost of Mounjaro with Passport will vary depending on several factors, including:
- Plan Deductible: The amount you must pay out-of-pocket before your insurance coverage begins.
- Coinsurance: The percentage of the medication cost you are responsible for after meeting your deductible.
- Copayment: A fixed amount you pay for each prescription, regardless of the cost of the medication.
Estimated Costs:
According to GoodRx, the average cost of Mounjaro without insurance is approximately $1,000 per month. However, with Passport coverage, the cost may be significantly lower, depending on your specific plan and coverage details.
How to Get Coverage for Mounjaro
To get coverage for Mounjaro with Passport, you will need to:
1. Enroll in a Passport Plan: Choose a Passport Medicare Part D prescription drug plan that covers Mounjaro.
2. Check Coverage: Contact Passport or visit their website to confirm coverage and any applicable restrictions.
3. Obtain Prior Authorization (if required): If prior authorization is required, complete the necessary paperwork and submit it to Passport for approval.
4. Get a Prescription: Obtain a prescription for Mounjaro from your healthcare provider.
5. Fill the Prescription: Take your prescription to a participating pharmacy to fill.
Alternative Coverage Options
If Passport does not cover Mounjaro or if the coverage is limited, you may explore alternative coverage options:
- Other Medicare Part D Plans: Consider other Medicare Part D plans that offer coverage for Mounjaro.
- Commercial Insurance: Check with your employer or individual health insurance provider to see if they cover Mounjaro.
- Manufacturer Assistance Programs: Eli Lilly, the manufacturer of Mounjaro, offers a patient assistance program that may provide financial assistance to eligible individuals.
Final Thoughts
Understanding the coverage and costs of Mounjaro with Passport is essential for accessing this important medication. By checking with your specific Passport plan and exploring alternative coverage options if necessary, you can optimize your coverage and minimize out-of-pocket expenses.
Answers to Your Questions
1. What is the typical dosage of Mounjaro?
Answer: The dosage of Mounjaro is individualized based on the patient’s response and tolerance. It typically starts with 2.5 mg once weekly and may be increased gradually to a maximum dose of 15 mg once weekly.
2. What are the potential side effects of Mounjaro?
Answer: Common side effects of Mounjaro include nausea, vomiting, diarrhea, constipation, abdominal pain, and injection site reactions.
3. Is Mounjaro a safe medication?
Answer: Mounjaro has been approved by the FDA for the treatment of obesity and type 2 diabetes. It has been shown to be generally safe and well-tolerated in clinical trials.
