Does SelectHealth Cover Mounjaro?
The verdict
Conditional on most plans
SelectHealth (the provider-owned plan from Intermountain Health) covers Mounjaro for type 2 diabetes with prior authorization across commercial, ACA, and Medicare lines in Utah and Idaho. SelectHealth does not cover Mounjaro for weight loss. Utah Medicaid is diabetes-only on GLP-1 coverage. The weight-loss tirzepatide product is Zepbound, with separate coverage. Regence (BCBS of ID/OR/UT/WA) overlaps SelectHealth in Utah and Idaho.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with SelectHealth using your member ID.
Key facts
SelectHealth is the provider-owned plan from Intermountain Health, concentrated in Utah and Idaho. Regence (BCBS of ID/OR/UT/WA) operates alongside SelectHealth in both states — both cover Mounjaro for T2D with PA.
SelectHealth / Regence Plan Information
Utah Medicaid is diabetes-only on GLP-1 coverage. Weight-loss GLP-1s (Wegovy, Zepbound) are not covered under Utah Medicaid.
Utah Department of Health and Human Services, Medicaid PDL
The 2026 Medicare Part D out-of-pocket cap is $2,100. Most Mounjaro users for diabetes who stay on therapy continuously reach this cap within 2–3 months and pay $0 for the rest of the year.
CMS Medicare Part D Redesign, 2026
Medicare vs. commercial coverage
Whether SelectHealth 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
SelectHealth Medicare Advantage and Part D plans cover Mounjaro for type 2 diabetes only — not weight loss — with prior authorization. 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 for the remainder of the year. 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), which covers weight-loss-approved products only. The Lilly savings card is not usable by Medicare or Medicaid beneficiaries.
Commercial / Employer
Group & marketplace plans
SelectHealth commercial and employer-sponsored plans: Mounjaro is covered for type 2 diabetes with prior authorization (A1c 6.5% or higher, metformin trial). Specific tier placement is not publicly confirmed at the drug level — verify on the SelectHealth formulary. Not covered for off-label weight loss under any plan design. ACA/Individual: diabetes only, PA; weight-loss GLP-1s commonly excluded. Utah Medicaid: diabetes-only; not covered for weight loss. Lilly savings card: $25/month with commercial coverage; $499/month without (max $647/month, up to 13 fills, expires 12/31/2026). Not available to Medicare or Medicaid beneficiaries.
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.
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 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
SelectHealth plan-specific brand cost-share; tier not publicly confirmed at the drug level — verify on the SelectHealth drug lookup. Commercially insured with Mounjaro coverage may pay as little as $25/month via the Lilly savings card. Utah Medicaid: nominal copay for covered T2D use. Medicare Part D: 25% coinsurance to the $2,100 OOP cap 2026; MFN $245/month mid-2026.
Typical monthly copay once prior authorization is approved.
Bridge program
The 2026 Medicare GLP-1 Bridge ($50/month) covers weight-loss-approved products only; Mounjaro is not included.
Reduced copay through the assistance program, where eligible.
All figures are estimates; confirm cost-share on the SelectHealth drug lookup tool. The Lilly savings card expires 12/31/2026 and is not available to Medicare, Medicaid, or government-program beneficiaries.
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
Verify Mounjaro coverage on the SelectHealth drug formulary
Visit selecthealth.org and use the drug lookup for your specific plan (Utah or Idaho). Confirm that PA is required, look up the current tier and cost-share, and verify the PA criteria. If you are also considering Regence (BCBS of Utah/Idaho), compare plan benefits — both cover Mounjaro for T2D with PA, but plan-specific cost-share may differ.
- 2
Have your prescriber submit a complete prior authorization
Your prescriber must document your T2D diagnosis (ICD-10 E11.x), A1c of 6.5% or greater within ~90 days, and prior metformin trial (plus one additional agent where required). Submit through the SelectHealth PA portal; allow up to 72 hours for a decision.
- 3
If you want tirzepatide for weight loss, ask about Zepbound — not Mounjaro
If your goal is weight loss rather than diabetes management, Mounjaro will be denied — it is diabetes-only and UT Medicaid is diabetes-only on GLP-1s. The weight-loss tirzepatide is Zepbound, FDA-approved for chronic weight management and OSA. Ask your prescriber and SelectHealth specifically about Zepbound coverage — it has a separate PA and coverage pathway.
Options if SelectHealth 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. May be on a preferred tier ahead of Mounjaro as step therapy on SelectHealth formularies.
Trulicity (dulaglutide)
FDA-approved for T2D. GLP-1 alternative; often used as a step-therapy agent before Mounjaro approval.
Jardiance (empagliflozin)
SGLT2 inhibitor for T2D with cardiovascular benefits. May be required step therapy before GLP-1 approval on SelectHealth plans.
Regence (UT/ID alternative)
Regence (BCBS of ID/OR/UT/WA) overlaps SelectHealth in Utah and Idaho. Both cover Mounjaro for T2D with PA. Compare plan benefits if you are in these states.
Zepbound (tirzepatide) — weight loss only
Same molecule as Mounjaro (tirzepatide) but FDA-approved for chronic weight management and OSA. UT Medicaid is diabetes-only — for weight-loss tirzepatide, ask about commercial Zepbound coverage separately.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
No. SelectHealth does not cover Mounjaro for weight loss under any line of business. Mounjaro is FDA-approved for type 2 diabetes only; the PA is gated on a T2D diagnosis — off-label weight-loss requests are denied. Utah Medicaid is diabetes-only on GLP-1 coverage. For weight loss, the same active ingredient (tirzepatide) is Zepbound, which has a separate FDA approval for chronic weight management and OSA.
Both SelectHealth and Regence cover Mounjaro for type 2 diabetes with prior authorization in Utah and Idaho. SelectHealth is a provider-owned plan from Intermountain Health; Regence is the BCBS multi-state licensee for Idaho, Oregon, Utah, and Washington. Both require standard PA (T2D diagnosis, A1c 6.5%, metformin trial). Plan-specific cost-share may differ — compare using each plan's drug lookup tool.
Utah Medicaid covers Mounjaro for type 2 diabetes with prior authorization at a nominal Medicaid copay. Utah Medicaid is diabetes-only on GLP-1 coverage — weight-loss GLP-1s are not covered. The Lilly savings card is not available to Medicaid beneficiaries. Verify current coverage on the Utah Medicaid PDL or SelectHealth member services.
No. The 2026 Medicare GLP-1 Bridge ($50/month, July 1 – December 31, 2027) covers weight-loss-approved products only — Wegovy, Foundayo, and the Zepbound KwikPen. Mounjaro is excluded because it is FDA-approved for type 2 diabetes, not weight loss. SelectHealth Medicare Advantage and Part D plans cover Mounjaro under standard Part D rules for T2D, with PA and the $2,100 annual OOP cap in 2026.
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SelectHealth covers Mounjaro for diabetes only, not weight loss — the weight-loss twin Zepbound is a separate, often-excluded question, and UT Medicaid is diabetes-only. For patients who want tirzepatide access without insurance, compounded tirzepatide from $149/mo (and compounded semaglutide from $49/mo) is available at getcurex.com/cl/glp — no insurance required, no prior authorization. This is compounded tirzepatide and is not the same medication as Mounjaro or Zepbound. 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 SelectHealth 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.