nancy_portland said:What about those of us whose insurance covers Mounjaro but at Tier 4 non-preferred? My copay before the savings card is $475/month. The savings card k…
A few options if you're in this situation:
- Ask your endo to submit a formulary exception with supporting clinical documentation (failed alternative therapies, A1C data, etc.) — I know you've tried this but sometimes the third attempt with additional documentation works
- Check if your plan has a separate specialty pharmacy that might process it differently
- Contact Lilly's Mounjaro Access Program directly at 1-833-807-6667 — they have patient support specialists who can sometimes intervene with insurance
- If all else fails, Lilly has an out-of-pocket option for Zepbound at reduced pricing that launched in late 2024. Depending on your dose, this might be cheaper than your current copay
Also — document everything. If you've failed metformin and/or other T2D therapies, that strengthens your case enormously for tier exceptions.
I pay $25/month. My insurance covers it at Tier 2 preferred and the savings card drops my $50 copay to $25. I know I'm insanely lucky and I'm terrified they'll change it every time I open my plan documents 😅
UPDATE: Called Lilly's support line. They were actually really helpful. Turns out CVS was running my insurance first, then the savings card, but they were inputting the BIN/PCN wrong. The support rep did a three-way call with CVS and walked them through it. Next fill should be $25.
Pro tip: if your pharmacy is messing up, call Lilly directly and ask for a three-way call. They'll fix it.
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Browse GL BiochemGreat tip MarkLI_maint, adding that to the OP. This is why I love this forum. Real people sharing real solutions. 🙌
Anyone have info on whether the savings card program is confirmed through end of 2026 or is there an expiration date we should worry about?
As of now, Lilly has not announced an end date for the savings program. These programs typically run as long as there's market competition (i.e., as long as Novo is running similar programs for Wegovy/Ozempic). My educated guess is it'll continue through at least 2027, but that's just my speculation — nothing official.
Keep an eye on the Mounjaro and Zepbound websites for updates. They've changed terms without much advance notice before.
— PharmD, retail + specialty experience, not representing any manufacturer