Does Quartz Health Solutions Cover Mounjaro?
The verdict
Conditional on most plans
Quartz Health Solutions (Wisconsin) covers Mounjaro for type 2 diabetes with prior authorization — the diabetes-only coverage pattern is inferred from the near-universal insurer baseline, not from a directly retrieved Quartz formulary line; verify on plan formulary. Mounjaro is not covered for weight loss under any line. Wisconsin Medicaid is diabetes-focused. The weight-loss tirzepatide is Zepbound, which has separate and often-excluded coverage.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with Quartz Health Solutions using your member ID.
Key facts
Quartz Health Solutions is a provider-owned Wisconsin regional plan. Its Mounjaro coverage for T2D follows the near-universal diabetes-only pattern, but drug-level tier specifics are not publicly confirmed — always verify directly on the plan formulary.
Quartz Health Solutions, member services; composite insurer pattern per CMS/PBM baseline data
The 2026 Medicare Part D out-of-pocket cap is $2,100. Most enrollees on Mounjaro for T2D reach this cap within 2–3 months and pay $0 for the remainder of the year.
CMS.gov, Medicare Part D Redesign 2025–2026
The IRA-negotiated Medicare MFN price for tirzepatide (Mounjaro) is $245/month, effective mid-2026 for Medicare enrollees.
CMS.gov, IRA Drug Price Negotiation Program, 2026
Medicare vs. commercial coverage
Whether Quartz Health Solutions covers Mounjaro depends heavily on which kind of plan you hold. They follow completely different rules — here's each one, side by side.
Medicare
Part D & Advantage plans
Quartz Medicare Part D plans cover Mounjaro for type 2 diabetes only — not weight loss — with prior authorization, per the standard Part D diabetes pattern. The 2026 Part D out-of-pocket cap is $2,100; most continuous Mounjaro users for diabetes reach it within 2–3 months and pay $0 thereafter. The IRA-negotiated Medicare MFN price of $245/month begins mid-2026. Mounjaro is NOT included in the 2026 Medicare GLP-1 Bridge ($50/month, July 1 – December 31, 2027), which covers weight-loss-approved products only (Wegovy, Foundayo, Zepbound KwikPen). The Lilly savings card is not usable by Medicare beneficiaries. Verify on the Quartz Medicare Part D formulary.
Commercial / Employer
Group & marketplace plans
Commercial/Employer: Quartz commercial plans cover Mounjaro for T2D with prior authorization (composite pattern — verify on Quartz formulary). Not covered for off-label weight loss. ACA/Individual: diabetes only, PA; weight-loss GLP-1s are commonly excluded. Verify on plan formulary for your specific Quartz ACA product. Medicaid (WI): Wisconsin Medicaid is diabetes-focused; Mounjaro is covered for T2D with PA per the WI PDL. Weight-loss GLP-1 use is excluded. The Lilly savings card is not available to Medicaid beneficiaries. Quartz is a provider-owned regional Wisconsin plan — drug-level formulary details are not publicly confirmed at the national level; always verify directly on the plan formulary or member services.
The 5 boxes you must tick to get approved
Commercial plans that will consider Mounjaro require prior authorization. Check off what applies to you to see how close you are — this is a guide, not a guarantee of approval.
0 of 5 requirements selected. Meet all 5 and you have a documented case for approval. Missing any one is the most common reason requests are denied.
Your cost, three ways
What Mounjaro actually costs you swings enormously depending on how it's covered. Here's the realistic range.
Paying cash
Approximately $1,300–$1,560/month retail (WAC ~$1,080). Lilly savings card: $499/month for commercially insured patients without coverage (max $647/month, up to 13 fills, expires 12/31/2026). Not available to Medicare or Medicaid beneficiaries.
List price with no coverage — before any manufacturer savings card.
With coverage
Commercial: plan-specific cost-share not publicly confirmed — verify on Quartz formulary. Lilly savings card: as low as $25/month for commercially insured patients with coverage. Medicare Part D: 25% coinsurance after deductible to the $2,100 OOP cap 2026; MFN $245/month mid-2026. WI Medicaid: nominal cost-share per WI PDL.
Typical monthly copay once prior authorization is approved.
Bridge program
The 2026 Medicare GLP-1 Bridge ($50/month) covers weight-loss-approved products only (Wegovy, Foundayo, Zepbound KwikPen). Mounjaro is not included.
Reduced copay through the assistance program, where eligible.
All figures are estimates; actual cost-share varies by Quartz product and pharmacy. Quartz is a regional composite plan — drug-level tier specifics are not publicly confirmed at the national level. Confirm tier and copay on the Quartz formulary or by calling member services. The Lilly savings card applies only to commercially insured patients and expires 12/31/2026.
Check YOUR exact coverage in 3 steps
General answers only get you so far. Here's how to confirm your own plan's decision in a few minutes.
- 1
Look up Mounjaro on the Quartz formulary
Visit quartzbenefits.com or call Quartz member services and request the drug formulary (plan drug list) for your specific product (commercial, ACA, or Medicare Part D). Search for 'Mounjaro' or 'tirzepatide'. Confirm it is listed for type 2 diabetes (E11.x), note the tier, and check whether prior authorization is required. As a regional Wisconsin plan, Quartz's drug-level coverage details may not appear on national drug-lookup tools — go directly to the plan.
- 2
Have your prescriber submit the prior authorization
Your prescriber must document your confirmed T2D diagnosis, A1c of 6.5% or higher, and prior oral agent step therapy (metformin plus typically one additional agent). Ask your prescriber's office to submit a PA request to Quartz. Verify the exact PA criteria on the Quartz formulary before submission, as criteria for regional composite plans may differ from national PBM baselines.
- 3
Call Quartz member services to confirm cost and Bridge eligibility
Call the number on the back of your Quartz card. Ask: Is Mounjaro covered for type 2 diabetes on my plan? What is my cost-share after prior authorization? Is the 2026 Medicare GLP-1 Bridge applicable to Mounjaro? (Answer: No — Mounjaro is excluded from the Bridge because it is a diabetes drug, not a weight-loss product.)
Options if Quartz Health Solutions won't cover Mounjaro
A denial isn't the end of the road. These are the paths people commonly explore next — discuss any of them with your prescriber.
Ozempic (semaglutide)
FDA-approved for type 2 diabetes. Often covered with PA on commercial and Medicare Part D plans; may be at a more favorable tier than Mounjaro — verify on Quartz formulary.
Trulicity (dulaglutide)
FDA-approved for T2D. GLP-1 alternative with lower list price than Mounjaro; often preferred tier on regional and Wisconsin Medicaid formularies — verify on Quartz plan.
Jardiance (empagliflozin)
SGLT2 inhibitor for T2D with cardiovascular benefits. Often preferred tier; may be required as step therapy before GLP-1 approval. Verify on Quartz formulary.
Zepbound (tirzepatide) — weight loss only
Same molecule as Mounjaro (tirzepatide) but FDA-approved for chronic weight management and obstructive sleep apnea — not diabetes. Has separate and often-excluded coverage; included in the 2026 Medicare GLP-1 Bridge for weight-loss-approved products. Wisconsin Medicaid focuses on diabetes GLP-1 coverage. Do not substitute Mounjaro for Zepbound — they are different FDA approvals.
These options are listed for information only — your own clinician decides what is appropriate for you.
Frequently Asked Questions
No. Mounjaro is FDA-approved for type 2 diabetes only — not weight loss. Quartz does not cover Mounjaro for off-label weight loss under any line. The weight-loss tirzepatide is Zepbound, with separate and often-excluded coverage. Wisconsin Medicaid focuses on diabetes GLP-1 coverage. If weight loss is your goal, verify Zepbound coverage separately on the Quartz formulary.
Quartz Health Solutions is a provider-owned regional Wisconsin plan, and its drug-level formulary details are not publicly confirmed at the national level. The diabetes-only coverage pattern is inferred from the near-universal insurer baseline — shared by Wisconsin regional peers Security Health Plan and Group Health Cooperative. Verify directly at quartzbenefits.com or by calling Quartz member services. Do not rely on national drug-lookup tools.
All three are Wisconsin/Upper-Midwest composite plans that follow the standard diabetes-only GLP-1 pattern. Security Health Plan is Marshfield-Clinic-owned; GHC is a member-owned cooperative; Quartz is provider-owned. None has publicly confirmed drug-level formulary details — all require direct verification with the plan. The Mounjaro-for-diabetes, Zepbound-for-weight-loss distinction applies equally across all three.
Commercial cost-share is not publicly confirmed for Quartz — verify on plan formulary. The Lilly savings card can reduce cost to as little as $25/month for commercially insured patients with coverage, or $499/month without (expires 12/31/2026; excludes Medicare and Medicaid). Medicare Part D: 25% coinsurance to the $2,100 OOP cap 2026; IRA-negotiated MFN price of $245/month begins mid-2026.
Wisconsin Medicaid is diabetes-focused and covers Mounjaro for T2D with prior authorization per the WI PDL. Weight-loss GLP-1 use is excluded. Mounjaro is not in the 2026 Medicare GLP-1 Bridge, which covers weight-loss-approved products only. Verify current WI Medicaid PDL status on Wisconsin's state Medicaid preferred drug list or by calling Quartz member services.
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You just saw how tangled Mounjaro coverage can get — auto-rejections, prior authorization, and high cash prices. Curex compounded semaglutide: $199/month equivalent prepaid annually ($2,388 upfront), or $299/month paid monthly. Compounded tirzepatide: $299/month equivalent prepaid annually ($3,588 upfront), or $399/month paid monthly. Commercial rates as of 2026-10-12; compounded products are not FDA-approved and clinical eligibility must be assessed. Curex compounded medications are not the same as Mounjaro. No insurance or prior authorization required; prescription required, subject to provider review.
- Medication + free shipping
- 24/7 provider access
- Medical intake & prescription review
Compounded semaglutide and tirzepatide are not the same medications as Mounjaro and are not branded or FDA-approved products. Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.
This content is for informational purposes only and does not constitute medical, financial, or insurance advice. Coverage rules, prior-authorization criteria, and copay amounts change frequently and vary by plan, formulary tier, and effective date — always verify current benefits directly with Quartz Health Solutions before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation. Curex offers compounded semaglutide and tirzepatide, which are not the same medications as Mounjaro and are not branded or FDA-approved products; prescription required, subject to provider review. Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.