Many health plans require that a Letter of Medical Necessity (LMN) accompany a coverage authorization appeals letter.
Savings are available to get your patients started on Mounjaro
Eligible, commercially insured patients may pay as little as $25 for a 1-month, 2-month, or 3-month prescription with the Mounjaro Savings Card Program.
One month is defined as 28 days and 4 pens. Two months is defined as 56 days and 8 pens. Three months is defined as 84 days and up to 12 pens.
Subject to Lilly USA, LLC's (Lilly's) right to terminate, rescind, revoke or amend the Mounjaro Savings Card Program ("Card" or "Program") eligibility criteria and/or Card terms and conditions which may occur at Lilly's sole discretion, without notice, and for any reason, the Card expires and savings end on 12/31/2024 for patients with commercial drug insurance with coverage for Mounjaro and 6/30/2024 for patients with commercial drug insurance who do not have coverage for Mounjaro. Card savings are not available to patients without commercial drug insurance or who are enrolled in any state, federal, or government funded healthcare program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medicare Advantage, Medigap, DoD, VA, TRICARE®/CHAMPUS, or any state prescription drug assistance program.
MONTHLY AND ANNUAL MAXIMUM SAVINGS: For patients with commercial drug insurance coverage for Mounjaro: You must have commercial drug insurance that covers Mounjaro®(tirzepatide) and a prescription consistent with FDA-approved product labeling to pay as little as $25 for a 1-month, 2-month, or 3-month prescription fill of Mounjaro. Month is defined as 28-days and up to 4 pens. Card savings are subject to a maximum monthly savings of up to $150 per 1-month prescription, $300 per 2-month prescription, or $450 per 3-month prescription fill and separate maximum annual savings of up to $1800 per calendar year. Card may be used for a maximum of up to 13 prescription fills per calendar year. Subject to Lilly USA, LLC's ("Lilly") right to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly's sole discretion, without notice, and for any reason, Card expires and savings end on 12/31/2024.
For patients with commercial drug insurance who do not have coverage for Mounjaro: You must have commercial drug insurance that does not cover Mounjaro and a prescription consistent with FDA-approved product labeling to obtain savings of up to $573 off your 1-month prescription fill of Mounjaro. Month is defined as 28-days and up to 4 pens. Card savings are subject to a maximum monthly savings of up to $573 and a separate maximum annual savings of up to $3,438 per calendar year. Card may be used for a maximum of up to 6 prescription fills per calendar year. Subject to Lilly's right to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly's sole discretion, without notice, and for any reason, Card expires and savings end on 06/30/2024.
ADDITIONAL TERMS AND CONDITIONS:
You are responsible for any applicable taxes, fees and any amount that exceeds the monthly or annual maximum benefits. Savings card activation is required. This Card may be terminated, rescinded, revoked, or amended by Lilly at any time without notice and for any reason. Subject to additional terms and conditions. Eligibility criteria and terms and conditions for the Mounjaro Savings Card Program may change from time to time at Lilly's sole discretion and for any reason; the most current version can be found at https://www.mounjaro.com/savings-resources#savings Card benefits void where prohibited by law.
For support and resources, visit the Mounjaro Self-Service Portal