What Insurance Covers Mounjaro for Diabetes?
What is Mounjaro (Tirzepatide)?
Mounjaro, referred to by its generic name tripeptide, is a drug formulated for type 2 diabetes management. It simulates the effect of two hormones—GLP-1 and GIP—on blood glucose levels. This drug is prescribed to be taken once weekly through subcutaneous injection and has demonstrated significant efficacy in lowering A1C levels, making it a promising addition to diabetes treatment.
Coverage by Insurance Plans for Mounjaro
●Approval Status: Eli Lilly's Mounjaro (tirzepatide) has been approved by India's Central Drug Standard Control Organisation (CDSCO) for type 2 diabetes treatment. It is set to be launched in India in 2025.
●Current Insurance Coverage: None of the health insurance plans in India currently cover Mounjaro. Patients will have to pay out-of-pocket until insurers make a decision otherwise.
●Factors Affecting Coverage: Insurance companies evaluate the clinical effectiveness, cost-effectiveness, and demand before covering new medications. Due to Mounjaro’s relatively new status in India, insurers may initially adopt a cautious approach.
●Future Coverage Possibilities: Reputed insurance companies, such as Star Health, may consider including Mounjaro in their coverage if it picks up demand and shows stable clinical benefits in the future. However, the inclusion can happen through regular policies or as an add-on rider option.
●Rising Demand for Diabetes Treatments: As diabetes diagnoses are on the rise in India, insurers might face increasing pressure to cover efficient treatments such as Mounjaro. The drug's benefits in regulating blood sugar could propel increased adoption.
●Advice for Patients: Patients can contact their health insurance companies directly for information on possible coverage. Keeping an eye on releases from leading insurers can offer real-time updates on any policy shifts in coverage.
The future of Mounjaro's availability in India looks bright, particularly from large insurers such as Star Health, but it will be based on its demand and established efficacy after launch.
How Star Health Insurance Covers Diabetes Treatments?
Star Health Insurance offers complete diabetes management through plans like the Star Diabetes Safe Insurance Policy. It covers hospitalization, complications, and treatment expenses and is available in two plan types.
Key benefits include:
●Pre-existing Diabetes Coverage: Covers hospitalization for diabetes-related complications from the initial policy year (under Plan A).
●Cataract Treatment: Expenses incurred for cataract treatment are covered up to the limits mentioned in the policy clause.
●Policy Type: Available on individual or family floater (maximum two members) basis.
Key Considerations for Getting Insurance Coverage for Mounjaro
●Formulary Check: Ensure that Mounjaro is listed on your health insurance provider's formulary.
●Prior Authorization: Prior authorization is mostly required for high-cost medicines to ensure medical necessity.
●Step Therapy: Requires patients to try a drug from its preferred medications list before it covers a non-preferred drug.
●OPD and Chronic Care Add-ons: To increase the likelihood of obtaining coverage for Mounjaro, choose OPD coverage or chronic care add-ons.
●Policy Terms: Review policy documents diligently to identify exclusions and co-payment terms applicable to speciality drugs.
It remains to be seen how major health insurers like Star Health provide coverage for Mounjaro under their policies. Until then, it is customary to opt for health insurance to remain protected against the high treatment costs related to diabetes management.
By doing so, you also increase your chances of getting coverage for Mounjaro if your health insurer allows it.
Check out the Star Diabetes Safe Insurance Policy for comprehensive protection!
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This FAQ page contains information for general purpose only and has no medical or legal advice. For any personalized advice, do refer company's policy documents or consult a licensed health insurance agent. T & C apply.