Does Kaiser Permanente 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
Spot an error? Report a correction
Covered with restrictions. Kaiser Northwest treats tirzepatide (Mounjaro) as non-formulary and covers it only through a criteria-based consultation program. For type 2 diabetes in adults it requires maximally tolerated metformin and other agents plus prior liraglutide and semaglutide failure, with HbA1c between 6.9% and 10%. Renewal for the weight-management pathway requires sustained 5% weight loss, and weight-loss use only applies to members with weight-loss drug coverage.
Applies to: Kaiser Permanente Northwest region, commercial; type 2 diabetes. Non-formulary, criteria-based. Other regions differ
Source: Kaiser Permanente Northwest: Criteria for Drug Coverage, tirzepatide (Mounjaro), Revised 2026-02-12; effective 2026-03-05
Policy details
Sources last checked October 18, 2026
Approval criteria
- Adults 20 and older with type 2 diabetes (not on insulin, or on less than 0.5 units/kg/day): HbA1c or GMI greater than 6.9% but less than 10% after an adequate trial of the therapies listed under step therapy.
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: tirzepatide (Mounjaro)
Step therapy
Type 2 diabetes (adults 20 and older): maximally tolerated metformin XR, a maximally tolerated sulfonylurea, pioglitazone and an SGLT2 inhibitor, or a contraindication or intolerance to each. Also maximum tolerated liraglutide (1.8 mg daily) for at least 3 months with HbA1c or GMI not below 7%, and maximum tolerated semaglutide (2 mg weekly) for at least 3 months, or a contraindication or intolerance to each. Chronic weight management: failure of a minimum 6-month semaglutide (Ozempic or Wegovy) trial, followed by a bariatric medicine chart review, unless there is an allergy, intolerance or contraindication to semaglutide.
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: tirzepatide (Mounjaro)
Approval length
12 months for chronic weight management
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: tirzepatide (Mounjaro)
Renewal criteria
- Updated weight and BMI are recently documented.
- Achieved and maintained 5% or greater weight loss after starting tirzepatide (Mounjaro).
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: tirzepatide (Mounjaro)
Exclusions and limits
- Covered for weight loss only for Kaiser Northwest members whose plan includes coverage for weight-loss medications. Others pay the member cash price.
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: tirzepatide (Mounjaro)
Policy
Revised 02/12/26, effective 03/05/26
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: tirzepatide (Mounjaro)
Effective March 5, 2026
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: tirzepatide (Mounjaro)
Region and plan differences
These criteria are for the Kaiser Permanente Northwest region (Kaiser Foundation Health Plan of the Northwest). Kaiser publishes criteria by region, and the document tells members to contact Pharmacy Services in their home region, so coverage in other regions can differ.
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: tirzepatide (Mounjaro)
What this means
The published policy lists approval criteria, step therapy, an initial approval of 12 months for chronic weight management, continuation criteria, 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.