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Eli Lilly has made some big changes to their savings card program for Mounjaro, starting 11/10/22.
First, there is such high demand for Mounjaro, they're applying the brakes because they are at risk of running short on product. They're asking pharmacies to prioritize fills for those who have T2D, since that's the only FDA approval they have right now.
In addition, they changed their savings card T&Cs for new patients after 11/10/22 where they will cover $500 off the retail price for those who have commercial insurance, but their insurance does not cover Mounjaro. Average retail price is $980 for 4 pens, which covers 28 days. And the maximum they'll pay is $3,000, which amounts to 6 months of fills.
For those who have commercial insurance that does cover Mounjaro, they'll cover $250 of the insurance copay amount for each fill, up to a maximum of $3,000. This is the better deal for those who are lucky enough to have insurance that does cover this drug.
I'm covered under the old savings card plan for now, and my savings card will expire 6/2023. After that, I'll need to switch to something else my insurance will cover.
Eli Lilly has made some big changes to their savings card program for Mounjaro, starting 11/10/22.
First, there is such high demand for Mounjaro, they're applying the brakes because they are at risk of running short on product. They're asking pharmacies to prioritize fills for those who have T2D, since that's the only FDA approval they have right now.
In addition, they changed their savings card T&Cs for new patients after 11/10/22 where they will cover $500 off the retail price for those who have commercial insurance, but their insurance does not cover Mounjaro. Average retail price is $980 for 4 pens, which covers 28 days. And the maximum they'll pay is $3,000, which amounts to 6 months of fills.
For those who have commercial insurance that does cover Mounjaro, they'll cover $250 of the insurance copay amount for each fill, up to a maximum of $3,000. This is the better deal for those who are lucky enough to have insurance that does cover this drug.
I'm covered under the old savings card plan for now, and my savings card will expire 6/2023. After that, I'll need to switch to something else my insurance will cover.
My guess is the drug is being used overwhelmingly for weight loss, rather than Type II diabetics. Here’s the difference, Type II diabetics who can show good control using the drug may be able to convince their insurance to cover off formulary, in part because it ends up saving the insurance company on far bigger bills in the form of ER visits and hospitalizations. I was able to do that with Victoza around 7 years ago. And, my husband and I saw it as such a miraculous drug we had already decided we were going to figure out how to cover the cost if they didn’t. That won’t happen with weight loss drugs and insurance companies, they aren’t going to see a drastic cut in ER visits. As far as out-of-pocket - if the person was that committed to sacrificing to be skinny, well…….let’s just say, they woukd have likely already found a different answer. Additionally, once the weight is lost, I assume the goal is to wean the person off the drug.
So, it’s use as a weight loss drug does not produce the desired life long consumer.
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In the beginning, Eli Lilly allowed anyone with commercial insurance to get the med for $25/month, even though the literature says it's only approved for T2D. Then it spun out of control with off-label use because of social media. They essentially created their own problem.
Lilly could get in trouble with the FDA if it looks like they're promoting an unapproved use of the drug when they are in their phase 2 / 3 drug trials for weightloss use, due for review in 2023.
Ironically, there are people with corporate insurance plans that do cover Mounjaro, and many are getting approval even though they don't have T2D. Those scripts are going through with no problem.
My insurance formulary does not cover this drug, period. They deny PA requests, or at least they denied the one my doctor sent and denied the appeal.
People who have T2D, but their insurance doesn't cover the med, are the ones being screwed over if they're just now being prescribed.
You can imagine all the drama swirling around over this. Plus, it's inconsistent with pharmacies -- some are processing scripts and not asking to prove T2D and others have put the hammer down and refusing to fill without proof of T2D. I use Walgreens, and they now require the Rx to have the diagnosis code. If it's not for T2D, they won't fill.
Last edited by lottamoxie; 11-13-2022 at 09:16 AM..
It's been just about 6 months and my doctor is very happy with my progress. I'd say the test with this new med has been a win. Forward and steady as she goes.
I moved down 1 Mounjaro dose in January and was thrilled to see my most recent tests show A1c 5.4 (down from 5.5 in Dec when I was on a higher dose), and fasting glucose tested 83. Both remain in normal range.
Other various CMP (comprehensive metabolic panel) numbers have improved as well. My doctor is very pleased, as I haven't been at these normal levels since...maybe 20 years, which is before I transferred to her practice.
Continuing Metformin...going on 24 years. The combination of Metformin + GLP1 has made a big difference.
Does anyone know how the doctors decide which medication to prescribe? I'm so sick of the insulin injections but the doctor doesn't want to change because they "work so well for me".
Mounjaro is now covered on my insurance formulary as of today!
If you're looking for GLP-1 meds your insurance may cover, check your formulary (usually available online through your health insurance company's website). April 1 is, apparently, when many formularies process their updates.
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There are hurdles to getting Mounjaro on many insurance plans, mine for sure, starting with having a documented dx of Type II Diabetes, completing required step therapy, and then a PA (prior authorization) has to be submitted. (Doc tried to get a PA last fall, and it was denied, and then the appeal was also denied.)
I have 1 more fill left on my savings card, so the timing of this formulary change, now covering MJ, is perfect.
An auspicious day!
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