How to Get Mounjaro in the USA

Mounjaro, the brand name for the medication tirzepatide, has garnered significant attention for its effectiveness in managing type 2 diabetes and its notable impact on weight loss. This guide offers a comprehensive overview of how to obtain Mounjaro in the USA, covering eligibility, the prescription process, insurance navigation and the implications of new regulations.

What is Mounjaro?

Mounjaro’s active ingredient is tirzepatide, a groundbreaking medication that is the first and currently only dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. It functions by mimicking these two natural incretin hormones.

This dual action leads to several beneficial effects: it stimulates the pancreas to release insulin when blood sugar levels are elevated, reduces the production of glucagon (a hormone that increases sugar output from the liver), slows down the process of gastric emptying (which helps individuals feel fuller for longer), and can reduce overall food intake.

Key benefits and clinical results

The clinical results for tirzepatide are compelling. For type 2 diabetes, Mounjaro has demonstrated significant reductions in hemoglobin A1c (HbA1c), a key marker of long-term blood sugar control. For instance, one major clinical trial showed an average HbA1c reduction of up to 2.3% with Mounjaro 15 mg. Studies have also indicated Mounjaro’s superiority in A1C reduction compared to other medications like semaglutide 1 mg.

Furthermore, substantial weight loss has been consistently observed. In Zepbound clinical trials, individuals without diabetes taking the 15 mg dose experienced an average body weight loss of 18%, while those with diabetes lost an average of 12%. Patients with type 2 diabetes taking Mounjaro 15 mg in clinical trials also saw significant weight loss, averaging around 25 pounds.

Who Qualifies for Mounjaro?

Eligibility Criteria for Weight Loss

For individuals seeking tirzepatide specifically for weight loss, the FDA-approved medication is Mounjaro. The eligibility criteria are as follows:

Body Mass Index (BMI) Requirements:

• Adults with a BMI of 30 kg/m2 or greater (defined as obesity).
• Adults with a BMI of 27 kg/m2 or greater (defined as overweight) who also have at least one weight-related comorbidity.

Required Comorbidities (for BMI ≥27 kg/m2):

• Common qualifying weight-related health conditions include hypertension (high blood pressure), dyslipidemia (abnormal levels of fats in the blood, such as high cholesterol), type 2 diabetes mellitus, obstructive sleep apnea (OSA), or established cardiovascular disease.

Eligibility for Non-Diabetics

While Mounjaro itself is FDA-approved for type 2 diabetes, a physician could prescribe Mounjaro “off-label” for weight loss in non-diabetic individuals. Off-label use means a drug is prescribed for a condition different from its FDA-approved indication.

Who Can’t Get Mounjaro?

Certain conditions and circumstances preclude the use of tirzepatide due to potential risks. These medications are potent and require careful evaluation by a healthcare professional. Key contraindications and restrictions include:

Contraindications

• A personal or family history of medullary thyroid carcinoma (MTC).
• Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• A history of serious hypersensitivity reaction (e.g., anaphylaxis, angioedema) to tirzepatide or any of its components.
• A history of pancreatitis: Mounjaro has not been studied in patients with a history of pancreatitis. Use with caution, or it may not be recommended.
• Severe gastrointestinal disease, including severe gastroparesis: Not recommended for these patients.

Age and Other Restrictions

• Age: Not approved for individuals under 18 years of age, as safety and efficacy in pediatric patients have not been established.
• Pregnancy: Tirzepatide should not be used during pregnancy due to the potential for fetal harm. If pregnancy occurs or is planned, discontinuation is advised.
• Breastfeeding: It is unknown if tirzepatide passes into breast milk. This should be discussed with a doctor.
• Oral Contraceptives: Tirzepatide may reduce the effectiveness of oral hormonal contraceptives. Women using these should be advised to switch to a non-oral contraceptive method or add a barrier method for 4 weeks after starting tirzepatide and for 4 weeks after each dose increase.

How to Get a Mounjaro Prescription

These medications are not available over-the-counter due to their potency, potential side effects, and the need for individualized medical assessment.

Steps to Getting Prescribed Mounjaro

1. Consultation with a Healthcare Provider: This is the mandatory first step. Schedule an appointment with a licensed healthcare professional, which can be an in-person visit or a telehealth consultation.
2. Medical Assessment: The provider will conduct a comprehensive assessment, including:

• Medical History: A detailed review of current and past health conditions (especially thyroid problems, history of pancreatitis, kidney disease, severe gastrointestinal issues, diabetes, diabetic retinopathy, depression, or suicidal thoughts), previous surgeries, and any allergies.
• Current Medications: A complete list of all prescription drugs, over-the-counter medications, vitamins, and herbal supplements you are taking.
• BMI and Comorbidities: Your Body Mass Index (BMI) will be calculated or verified. If seeking Mounjaro for weight loss, the presence of qualifying weight-related comorbidities will be assessed.
• Lab Tests: Your provider may order blood tests to evaluate your overall health and suitability for the medication. Common tests can include an A1c (for diabetes or prediabetes), a lipid panel (cholesterol), kidney and liver function tests, and thyroid function tests. In some cases, if a risk of medullary thyroid carcinoma is suspected, serum calcitonin levels might be checked.

3. Discussion of Goals and Lifestyle

An open conversation about your health goals (e.g., improving blood sugar, losing weight), your previous attempts at weight loss or diabetes management, and your expectations for treatment.

The provider will emphasize that Mounjaro is intended to be used as an adjunct to lifestyle changes, including a reduced-calorie diet and increased physical activity.

How to Ask Your Doctor for Mounjaro

Preparing for your doctor’s appointment can lead to a more productive discussion.

Preparation for Your Appointment

1. Gather your complete medical history, including dates of diagnoses and treatments.
2. Make a list of all medications you currently take, including dosages.
3. Document your previous weight loss attempts, including what you tried, for how long, and the outcomes.
4. Think about your weight concerns or diabetes management challenges and how they affect your daily life and health.

Questions to Ask Your Doctor

• Based on my health profile, am I a good candidate for Mounjaro (for weight loss/OSA)? 
• What are the specific benefits I might expect, and what are the potential risks and common side effects? 
• How does this medication work in the body? 
• What kind of diet and exercise changes will I need to make for this medication to be most effective?
• Are there other treatment options I should consider?
• How might this medication interact with my other medications?
• What is the starting dose, how is it increased, and how will we monitor my progress and any side effects?
• What is the approximate cost, and what is the likelihood of my insurance covering it?

Information to Provide Your Doctor:

Be completely honest and thorough about your medical history. This includes any personal or family history of thyroid cancer (specifically MTC), pancreatitis, severe stomach or digestive problems, kidney disease, diabetic retinopathy, or any history of depression or suicidal thoughts.

Provide a comprehensive list of all medications, supplements, and any known allergies.

Online Doctors and Telehealth Options

Telehealth services offer a convenient way to consult with a healthcare provider and potentially receive a prescription for Mounjaro.

How to get a Mounjaro prescription online

The process to get an online prescription typically involves:

Online Questionnaire/Intake: Complete a detailed health questionnaire covering your medical history, weight journey and current medications.

Consultation: A virtual consultation with a licensed healthcare provider. Increasingly, especially with evolving 2025 guidelines aimed at enhancing patient safety.

Review and Lab Orders: The provider reviews your information. If necessary, they may order lab tests to confirm eligibility or assess baseline health markers.

Prescription (if appropriate): If the provider determines the medication is suitable and safe for you, they will write a prescription.

Choosing reputable telehealth providers

When you are choosing a telehealth provider, look for services that:

• Contact only licensed healthcare professionals in your state.
• Conduct comprehensive medical assessments, including video consultations for these types of medications, aligning with best practices and newer regulatory expectations.
• Clearly outline costs, what their service includes (e.g., consultation fees, medication costs, ongoing support).

What to expect during an online consultation

During an online consultation, expect a detailed discussion similar to an in-person visit, covering your medical history, current health, medications, allergies, risks and benefits of the treatment, necessary lifestyle changes, and an opportunity to ask questions.

What If You Don’t Have Diabetes?

Mounjaro could be prescribed off-label for weight loss, but this is at the doctor’s discretion and insurance coverage is highly unlikely, especially with Zepbound being the on-label alternative. This distinction is vital because insurance companies are far more likely to cover a medication for its specific FDA-approved indication.

How to get approved for Mounjaro without diabetes?

Successfully navigating insurance for these medications requires understanding your plan’s specifics:

• Check the Formulary: First, consult your insurance plan’s formulary (its list of covered drugs) to determine if Mounjaro or Zepbound is included and at what tier, as this impacts your copayment.
• Prior Authorization (PA): Due to their cost and specific indications, most insurance plans require prior authorization for Mounjaro and Zepbound. This is a process where your doctor must submit documentation to the insurance company to justify the medical necessity of the prescribed medication before it will be covered.
• Step Therapy: Some insurance plans enforce “step therapy,” meaning you may be required to try one or more alternative, often less expensive, medications for your condition and find them ineffective or intolerable before the plan will approve Mounjaro

Documentation typically needed for Prior Authorization includes:

• Diagnosis Confirmation
• Medical History
• Lifestyle Intervention Proof
• Previous Medication Trials
• Relevant Lab Results

What If Insurance Denies Coverage?

If your insurance plan denies coverage for Mounjaro, or if you are uninsured, several options may be available:

1. Lilly Cares Foundation: Eli Lilly operates the Lilly Cares Foundation Patient Assistance Program, which may provide certain Lilly medications, potentially including Mounjaro. his program is generally for uninsured or underinsured U.S. residents who are experiencing financial hardship.
2. Manufacturer Savings Cards: Eli Lilly offers savings cards for both Mounjaro and Zepbound for eligible, commercially insured patients (those not covered by government programs like Medicare or Medicaid).

Where to Fill Your Mounjaro Prescription

Once a valid prescription for Mounjaro is obtained, patients have several options for where to fill it: 

1. Retail Pharmacies: Most national and local retail pharmacies, such as CVS, Walgreens, Walmart, and Costco, can fill prescriptions for Mounjaro.
2. Mail-Order Pharmacies: Many mail-order pharmacies, including larger online pharmacies like Amazon Pharmacy, can also dispense these medications.

Can You Get Mounjaro Without a Prescription?

No, it is not possible to legally or safely obtain Mounjaro in the USA without a valid prescription from a licensed healthcare professional. These medications are classified as prescription-only drugs for critical reasons related to patient safety and appropriate use.

What to Expect After Getting Mounjaro

Starting Dose

Treatment typically begins with a dose of 2.5 mg of tirzepatide injected subcutaneously once weekly for the first 4 weeks.

Titration Schedule

After 4 weeks on the 2.5 mg dose, the dosage is usually increased to 5 mg once weekly.9

If additional glycemic improvement or weight loss is needed, and the current dose is well-tolerated, the healthcare provider may further increase the dosage in 2.5 mg increments (e.g., to 7.5 mg, then 10 mg, then 12.5 mg).

Required Lifestyle Changes

Mounjaro is FDA-approved as an adjunct to diet and exercise; they are not intended as a standalone treatment. Sustained success with these medications is closely linked to the adoption and maintenance of healthy lifestyle habits.

Dietary Recommendations

A reduced-calorie, nutritious diet is fundamental. While individual plans may vary, general guidelines often include:

• Protein
• Fats
• Carbohydrates
• Fiber

Exercise Recommendations: Regular physical activity is crucial. This may include aerobic and strength training.

See also American Diabetes Association recommendations.

Frequently Asked Questions

Q1 – Can non-diabetics take Mounjaro?

A doctor can prescribe Mounjaro off-label for weight loss in non-diabetics, but Zepbound is the FDA-approved option for this purpose, and insurance is unlikely to cover Mounjaro for off-label weight loss.

Q2 – How do I get my doctor to prescribe Mounjaro?

Schedule a consultation and be prepared to thoroughly discuss your medical history, current health status, and other relevant details. Your doctor will then assess if Mounjaro is a medically appropriate and safe choice for you based on FDA guidelines.

Q3 – Who can prescribe Mounjaro?

Mounjaro must be prescribed by a licensed healthcare professional who is authorized to prescribe medications in your state.

Q4 – How long does it take to get approved?

If your insurance plan requires prior authorization for Mounjaro, the approval timeline can vary significantly. It might take anywhere from a few business days to several weeks.

Q5 – Can I get Mounjaro for weight loss only?

A doctor may prescribe you Mounjaro for weight loss only if they analyze that you were not able to lose weight using the FDA-approved drugs for this purpose.

Q6 – What if I don’t meet the eligibility criteria?

If you do not meet the specific FDA-approved eligibility criteria for Mounjaro, your doctor may not be able to prescribe it. In this case, it is important to discuss alternative treatments or strategies for managing your condition with your healthcare provider.

Q7 – What happens if I take Mounjaro without diabetes?

If a doctor prescribes Mounjaro off-label for weight loss to an individual without diabetes, the physiological effects related to appetite suppression and weight reduction would be similar to those experienced with Zepbound, as they contain the same active ingredient.