Does Aetna cover Mounjaro?
From published formulary and policy documents for the plan type below. Not a decision for your member ID.
Sources last checked October 24, 2026
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Covered with restrictions. Mounjaro carries step therapy and quantity limit flags on the CVS Caremark Value Formulary dated 07/01/2026. Caremark prior authorization policy 5694-D approves Mounjaro for type 2 diabetes when the patient has a documented A1C of 6.5 percent or higher or meets one of the other listed glucose criteria, with no metformin trial required and a 36-month approval. Aetna also publishes its own Mounjaro policy (5468-C, 05-2024 edition), which asks for an inadequate response to, intolerance of or contraindication to metformin and limits fills to 4 pens per 21 days, and its page does not clearly say which plans it applies to. Confirm which policy applies to your plan.
Applies to: Commercial/employer (Aetna non-Medicare prescription drug plan); type 2 diabetes indication only
Source: Caremark prior authorization policy 5694-D; Aetna policy 5468-C (Mounjaro), Policy 5694-D (no revision date stated); Aetna 5468-C UDR 05-2024
Policy details
Sources last checked October 18, 2026
Approval criteria
- Documented type 2 diabetes with at least one of: a history of A1C of 6.5 percent or higher; a 2-hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test; symptoms of high blood sugar or a hyperglycemic crisis plus a random plasma glucose of 200 mg/dL or higher; or a fasting plasma glucose of 126 mg/dL or higher after at least 8 hours of fasting. Documentation is required for each.
Source: CVS Caremark prior authorization policy 5694-D, Antidiabetic GLP-1 and GIP/GLP-1 agonists
Step therapy
This policy does not require a metformin trial before approval. A metformin fill at least 10 days before the claim can let a claim pay without prior authorization, but it is not a requirement for approval.
Source: CVS Caremark prior authorization policy 5694-D, Antidiabetic GLP-1 and GIP/GLP-1 agonists
Approval length
36 months
Source: CVS Caremark prior authorization policy 5694-D, Antidiabetic GLP-1 and GIP/GLP-1 agonists
Exclusions and limits
- Weight loss is not listed as an indication in this policy, which covers blood sugar control in type 2 diabetes and reducing major cardiovascular events.
Source: CVS Caremark prior authorization policy 5694-D, Antidiabetic GLP-1 and GIP/GLP-1 agonists
Policy
Caremark policy 5694-D; the document states no revision date
Source: CVS Caremark prior authorization policy 5694-D, Antidiabetic GLP-1 and GIP/GLP-1 agonists
What this means
The published policy lists approval criteria, step therapy, an initial approval of 36 months, and uses that are not covered.
This reflects the insurer's published formulary and policy for the plan type above. Your employer or plan may exclude weight-loss drugs or differ. Confirm with the number on your ID card.