Does Priority Health Cover Tirzepatide (Mounjaro)

Discover if Priority Health covers Tirzepatide. Learn reasons for coverage denial, steps to secure it, cost details, and FAQs in our comprehensive guide.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Does Priority Health Cover Tirzepatide (Mounjaro)

 

  • Eligibility for Coverage: Priority Health may cover Tirzepatide (Mounjaro) for patients diagnosed with type 2 diabetes, provided other medical conditions are met.
  •  

  • Medical Necessity: Coverage usually requires documentation from a healthcare provider proving that Mounjaro is necessary due to inadequate control of blood glucose levels with other medications.
  •  

  • Prior Authorization: Patients often need prior authorization, meaning healthcare providers must confirm their treatment plan meets Priority Health’s criteria before prescription costs are covered.
  •  

  • Specific Plan Details: The specific terms of coverage vary depending on the patient’s insurance plan with Priority Health, so reviewing individual plan documents is essential.
  •  

  • Contacting Support: For more detailed and personalized information, it’s advisable to contact Priority Health directly or consult with a healthcare provider.

 

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Tirzepatide (Mounjaro) Coverage with Priority Health

 

Understand the Coverage Requirements

 

  • Check the specific criteria set by Priority Health for Tirzepatide (Mounjaro) coverage. This often includes requirements related to medical necessity, prior authorizations, or specific patient conditions.
  •  

  • Review Priority Health’s formulary or your specific plan details to ensure Tirzepatide (Mounjaro) is listed as a covered drug.

 

Consult with Your Healthcare Provider

 

  • Speak with your doctor to determine if Tirzepatide is appropriate for your treatment. Your healthcare provider may need to provide documentation supporting the medical necessity of this medication.
  •  

  • Ask your doctor to initiate any necessary prior authorization forms or documentation required by Priority Health.

 

Reach Out to Priority Health

 

  • Contact Priority Health member services via phone or through your online account to confirm coverage requirements and processes for Tirzepatide (Mounjaro).
  •  

  • Request detailed information about any required documentation, the prior authorization process, and any specific criteria that need to be met.

 

Prepare and Submit Necessary Documentation

 

  • Work with your healthcare provider to complete and submit all necessary forms and supporting documents for the prior authorization process. This may include medical records, treatment history, and rationale for using Tirzepatide.
  •  

  • Ensure that all documents are clear, accurately filled out, and sent promptly to avoid delays in processing.

 

Follow Up on Your Request

 

  • Stay in touch with both Priority Health and your healthcare provider to monitor the status of your prior authorization request.
  •  

  • If your request is initially denied, ask for clarification and consider appealing the decision, providing any additional information or corrections needed.
  •  

  • Maintain records of all communications and submissions for future reference.

 

Explore Alternative Options

 

  • If your request for coverage is denied, discuss alternative medications or treatment strategies with your healthcare provider that may be covered under your plan.
  •  

  • Consider discussing patient assistance programs or discounts offered by the medication manufacturer as interim solutions.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Priority Health Cover Tirzepatide (Mounjaro)

Discover if Priority Health covers Tirzepatide. Learn reasons for coverage denial, steps to secure it, cost details, and FAQs in our comprehensive guide.
Curex allergy drops unboxing

Is Tirzepatide (Mounjaro) Covered by Priority Health

 

Does Priority Health Cover Tirzepatide (Mounjaro)

 

  • Eligibility for Coverage: Priority Health may cover Tirzepatide (Mounjaro) for patients diagnosed with type 2 diabetes, provided other medical conditions are met.
  •  

  • Medical Necessity: Coverage usually requires documentation from a healthcare provider proving that Mounjaro is necessary due to inadequate control of blood glucose levels with other medications.
  •  

  • Prior Authorization: Patients often need prior authorization, meaning healthcare providers must confirm their treatment plan meets Priority Health’s criteria before prescription costs are covered.
  •  

  • Specific Plan Details: The specific terms of coverage vary depending on the patient’s insurance plan with Priority Health, so reviewing individual plan documents is essential.
  •  

  • Contacting Support: For more detailed and personalized information, it’s advisable to contact Priority Health directly or consult with a healthcare provider.

 

A weight management program tailored to you

Start with Curex

Priority Health's Approved Criteria for Tirzepatide (Mounjaro) Coverage

 

Eligibility Criteria for Tirzepatide Coverage

 

  • Applicant must be diagnosed with type 2 diabetes mellitus.
  •  

  • Tirzepatide is intended for use as an adjunct to diet and exercise to improve glycemic control.
  •  

  • Prior use of at least one other antidiabetic agent, such as metformin, unless contraindicated or not tolerated.

 

Body Mass Index (BMI) Considerations

 

  • A BMI of ≥30 kg/m², or
  •  

  • A BMI of ≥27 kg/m² with at least one weight-related comorbidity (e.g., hypertension, dyslipidemia, obstructive sleep apnea).

 

Documentation Requirements

 

  • Submission of recent lab results indicating inadequate control of type 2 diabetes with current treatment regimen.
  •  

  • Documented attempts of lifestyle modifications, including diet and exercise, over a recent period.
  •  

  • Proof of regular follow-up appointments with a healthcare provider.

 

Prescriber Qualifications

 

  • Prescription must be provided by an endocrinologist or a healthcare provider specializing in diabetes management.
  •  

  • The prescriber should provide an established, individualized diabetes treatment plan that includes the use of Tirzepatide.

 

Continuation of Coverage

 

  • Evidence of HbA1c reduction or other clinical improvements within the first six months of treatment.
  •  

  • Periodic assessment and documentation of patient adherence to the prescribed treatment plan.

 

Age Requirements

 

  • Tirzepatide is covered for patients aged 18 years and older only.

 

Why Priority Health Might Deny Tirzepatide (Mounjaro) Coverage

 

Reasons for Denial of Tirzepatide (Mounjaro) Coverage by Priority Health

 

  • **Non-Medically Necessary**: Priority Health may deny coverage if Tirzepatide is deemed not medically necessary for the member's condition. The decision is based on clinical guidelines and medical necessity criteria.
  •  

  • **Lack of Prior Authorization**: If a prior authorization is required and not obtained before the prescription, coverage for Tirzepatide may be denied. This step is necessary to ensure that the use of the medication aligns with Priority Health's protocols.
  •  

  • **Off-Label Use**: Coverage might be denied if Tirzepatide is prescribed for an off-label use that is not supported by sufficient clinical evidence or Priority Health’s approved medication use criteria.
  •  

  • **Excluded Drug Class**: Tirzepatide may belong to a drug class or specific treatments that are excluded from coverage under certain plans provided by Priority Health.
  •  

  • **Policy Exclusions**: Some health plans might have specific exclusions that apply to particular medications, including Tirzepatide, as outlined in the member's individual policy documents.
  •  

  • **Experimental or Investigational**: If Tirzepatide is considered experimental or investigational for the given diagnosis by Priority Health, coverage can be denied. This determination is made based on current medical literature and regulatory approvals.
  •  

  • **Failure to Meet Specific Coverage Criteria**: Coverage may be denied if the prescribing of Tirzepatide does not meet specific criteria laid out by Priority Health, such as dosage limits, treatment durations, or step therapy requirements.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Tirzepatide (Mounjaro) Cost without Insurance?

 

Cost of Tirzepatide (Mounjaro) Without Insurance

 

  • The approximate cost of Tirzepatide, commonly known by its brand name Mounjaro, can vary based on several factors including the pharmacy location and any available discounts.
  •  

  • On average, the price for four doses of Mounjaro, which is typically a one-month supply, is estimated to be between $1,000 and $1,250 without any insurance coverage.
  •  

  • It's essential for patients to check with different pharmacies and consider available savings programs or manufacturer coupons which might offer significant reductions or discounts.
  •  

  • Additionally, some pharmacies might provide membership programs or discount cards that could further lower the costs.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Tirzepatide (Mounjaro) Coverage with Priority Health

 

Understand the Coverage Requirements

 

  • Check the specific criteria set by Priority Health for Tirzepatide (Mounjaro) coverage. This often includes requirements related to medical necessity, prior authorizations, or specific patient conditions.
  •  

  • Review Priority Health’s formulary or your specific plan details to ensure Tirzepatide (Mounjaro) is listed as a covered drug.

 

Consult with Your Healthcare Provider

 

  • Speak with your doctor to determine if Tirzepatide is appropriate for your treatment. Your healthcare provider may need to provide documentation supporting the medical necessity of this medication.
  •  

  • Ask your doctor to initiate any necessary prior authorization forms or documentation required by Priority Health.

 

Reach Out to Priority Health

 

  • Contact Priority Health member services via phone or through your online account to confirm coverage requirements and processes for Tirzepatide (Mounjaro).
  •  

  • Request detailed information about any required documentation, the prior authorization process, and any specific criteria that need to be met.

 

Prepare and Submit Necessary Documentation

 

  • Work with your healthcare provider to complete and submit all necessary forms and supporting documents for the prior authorization process. This may include medical records, treatment history, and rationale for using Tirzepatide.
  •  

  • Ensure that all documents are clear, accurately filled out, and sent promptly to avoid delays in processing.

 

Follow Up on Your Request

 

  • Stay in touch with both Priority Health and your healthcare provider to monitor the status of your prior authorization request.
  •  

  • If your request is initially denied, ask for clarification and consider appealing the decision, providing any additional information or corrections needed.
  •  

  • Maintain records of all communications and submissions for future reference.

 

Explore Alternative Options

 

  • If your request for coverage is denied, discuss alternative medications or treatment strategies with your healthcare provider that may be covered under your plan.
  •  

  • Consider discussing patient assistance programs or discounts offered by the medication manufacturer as interim solutions.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Tirzepatide (Mounjaro) FAQ

What are common side effects of Tirzepatide (Mounjaro)?

 

Common Side Effects of Tirzepatide (Mounjaro)

 

  • Nausea: Frequently reported, especially when starting treatment or increasing the dose.
  •  

  • Diarrhea: Some patients experience loose stools during treatment.
  •  

  • Decreased Appetite: Commonly occurs and can aid in weight management.
  •  

  • Vomiting: May happen occasionally, often alongside nausea.
  •  

  • Constipation: Some individuals might experience slower bowel movements.
  •  

  • Abdominal Pain: Discomfort or pain may occur during therapy.
  •  

  • Fatigue: A feeling of tiredness or exhaustion might present itself in some users.
  •  

  • In rare cases, hypoglycemia occurs, especially if combined with insulin or sulfonylureas.

 

How does Tirzepatide (Mounjaro) help with weight loss?

 

How Tirzepatide Aids Weight Loss

 

  • Dual Agonist Action: Tirzepatide acts on both GLP-1 and GIP receptors. These hormones help regulate appetite and glucose, influencing energy balance and metabolism.
  •  

  • Appetite Suppression: By mimicking these hormones, it reduces hunger, promoting lower calorie intake.
  •  

  • Increased Satiety: Delays gastric emptying, enhancing fullness and reducing meal frequency.
  •  

  • Improved Blood Sugar Control: Helps stabilize blood glucose levels, reducing insulin spikes that can stimulate hunger.
  •  

  • Enhanced Energy Expenditure: Modulates metabolic pathways to increase calorie burning, aiding fat loss.

 

Is Tirzepatide (Mounjaro) the same as Ozempic or Wegovy?

 

Comparing Tirzepatide with Ozempic and Wegovy

 

  • Composition: Tirzepatide (Mounjaro), Ozempic, and Wegovy are different medications. Tirzepatide is a dual GIP and GLP-1 receptor agonist, whereas Ozempic and Wegovy contain semaglutide, a GLP-1 receptor agonist.
  •  

  • Indications: Both Ozempic and Mounjaro target type 2 diabetes, but Wegovy is approved mainly for chronic weight management.
  •  

  • Mechanism: All induce insulin secretion and appetite suppression, yet Mounjaro's dual action may offer distinct benefits in glucose control and weight loss.
  •  

  • Dosage and Administration: Dosage forms and protocols vary; always follow medical guidance specific to the prescribed drug.
  •  

  • Considerations: Always consult your healthcare provider to determine the best option based on personal health needs and conditions.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Made in Webflow