How Much is Mounjaro Without Insurance?

The cost of Mounjaro without insurance is approximately $1,580 for a 28-day supply, which translates to nearly $19,000 annually. As a seasoned professional in the insurance industry for over a decade, working with Hotaling Insurance Services, I’ve seen firsthand the challenges and questions many face when it comes to understanding health insurance deductibles and their impact on prescription drugs. Today, we’re diving deep into a specific medication that’s been gaining attention: Mounjaro. For those managing diabetes or looking into weight management options, Mounjaro has emerged as a promising treatment. However, the cost question, especially “how much is Mounjaro without insurance,” remains a significant concern for many.

Mounjaro Without Insurance Upfront Costs

The upfront costs of Mounjaro can vary depending on several factors, including where you purchase it and any discounts or assistance programs you might use. Without insurance, Mounjaro’s price is approximately $1,135.24 for a 2 milliliter supply, which typically includes four 0.5 milliliter pen injectors​​. However, there are several ways to potentially reduce these costs:

1. Discount Programs and Savings Cards: Eli Lilly offers a Mounjaro Savings Card that can significantly reduce out-of-pocket costs for eligible patients. For those with commercial insurance coverage for Mounjaro, the savings could be as low as $25 per prescription. Without insurance coverage, you might save up to $575 off a 28-day prescription fill, with a maximum annual savings limit​​.
2. Pharmacy Programs: Some pharmacy discount programs and savings cards like Blink Health, Costco Member Prescription Program, Optum Perks, and ScriptSave WellRX claim to offer up to 80% off on prescriptions, which might include Mounjaro at participating pharmacies​​.
3. Patient Assistance Programs (PAPs): Programs sponsored by pharmaceutical companies or non-profit organizations might offer Mounjaro at a reduced cost or for free to those who qualify based on income, insurance status, and medical need. The Patient Access Network Foundation is one example where eligible patients might receive assistance​​.
4. Exploring Other Insurances: It’s worth checking if your Medicaid or Medicare plan covers Mounjaro, as coverage can vary. Some plans may cover it for the treatment of type 2 diabetes but not for weight loss, which is considered an off-label use​​.

Case Study

In this case study focusing on the financial aspects of accessing Mounjaro, we examine Alex’s journey, a patient navigating the complexities of managing Mounjaro costs for weight management under a high deductible health plan. Initially facing the daunting price of approximately $1,580 for a 28-day supply without insurance coverage, Alex was confronted with the challenge of covering this cost out-of-pocket due to their plan’s high deductible.

Determined to find a financially viable way to access Mounjaro, Alex explored several avenues:

• Patient Assistance Programs: Alex applied for Eli Lilly’s patient assistance program, designed to help patients facing financial hardships. Through this program, Alex was able to receive Mounjaro at a significantly reduced cost, contingent on meeting specific eligibility criteria.
• Health Savings Accounts (HSAs): Alex also took advantage of pre-tax savings through an HSA. Given the high cost of Mounjaro, the tax savings from using HSA funds effectively reduced the net expense. Assuming a 25% tax bracket, Alex saved around $395 on each purchase of Mounjaro by using HSA funds, effectively reducing the monthly cost burden.

By leveraging these financial strategies, Alex was able to manage the high cost of Mounjaro, turning an initially unaffordable treatment into a manageable part of their healthcare regimen. This case study underscores the critical importance of thoroughly exploring all available financial resources, including patient assistance programs and HSAs, to navigate the high costs associated with prescription medications under high deductible health plans.

What’s New

Recent studies have shown that Mounjaro’s effectiveness is not only in managing conditions but also in how patients can access it financially. With the rising adoption of health savings accounts (HSAs) and patient assistance programs, there’s a growing number of options for individuals to afford their medications despite high deductibles. Moreover, insurance negotiations and preventive care designations are becoming more prevalent, offering new avenues for cost reduction.

1. Eli Lilly’s Patient Assistance Program: For eligible patients, this program can significantly reduce the cost of Mounjaro. While the exact savings can vary, some patients might qualify to receive their medication for free or at a reduced price, depending on their income, insurance status, and other factors. Patients are encouraged to apply through the program’s website or by contacting Eli Lilly directly to understand their eligibility.
2. Health Savings Accounts (HSAs): Patients using HSAs can pay for Mounjaro with pre-tax dollars. Assuming an average cost of $1,580 for a 28-day supply, and considering the tax benefits (depending on the patient’s tax bracket, which could range from 10% to 37% federally), this could result in savings of $158 to $584 per month on their medication, effectively reducing the annual cost impact.
3. Insurance Negotiations: While specific numbers can vary widely based on the patient’s insurance plan and negotiation outcomes, some insured patients might see their co-pay for Mounjaro reduced to a set amount per month, such as $25 to $100, under their plan’s specialty medication coverage after meeting their deductible.
4. Copay Cards and Discount Programs: Eli Lilly offers a Mounjaro Savings Card for eligible commercially insured patients, which could lower copay costs to as little as $25 per month. This represents a significant reduction from the full cost for patients who qualify.

Mounjaro Discounts Without Insurance

1. Eli Lilly’s Patient Assistance: Eli Lilly offers a Mounjaro Savings Card, which could significantly reduce costs for eligible patients​​.
2. SingleCare and GoodRx: Both offer coupons that can help lower the price of Mounjaro. Prices with these coupons can vary by pharmacy, but they may offer substantial savings​​.
3. Medicaid and TRICARE: If you’re a beneficiary of Medicaid or TRICARE, it’s advised to check with your plan to see if Mounjaro is covered, which could potentially lower your costs​​.
4. NowPatient’s Rx Advantage Card: This card offers a way to potentially get Mounjaro at a lower cost than your plan’s copay, especially useful for those paying out of pocket​​.
5. Patient Assistance Programs (PAPs): For those who might not afford Mounjaro, PAPs sponsored by pharmaceutical companies could offer the medication at a reduced cost or even for free, depending on eligibility​​.
6. Manufacturer Coupons & Discount Cards: Using a Mounjaro coupon or discount card from the manufacturer or other sources can also help save money. These discounts can be applied at pharmacies upon purchase​​.
7. Alternative Medications: Consulting with your healthcare provider about lower-cost alternatives to Mounjaro, such as other GLP-1 receptor agonists, might be an option. While there might not be direct alternatives with the same mechanism, other medications could offer similar benefits​​.
8. NiceRx Program: Offers Mounjaro at a cost of $49 per month under specific conditions, providing an alternative route for those seeking cost-effective options​​.
9. Pharmaceutical Co-pay Programs: Some companies run co-pay programs that directly lower out-of-pocket costs for eligible patients, which might be worth exploring if you’re commercially insured​​.
10. Exploring State, Federal, or Other Government Insurance Options: If you’re not eligible for a co-pay program due to government insurance, other forms of assistance like LIS (Low Income Subsidy) might be available​​.

Top 11 Tips for Understanding Mounjaro Costs

1. Understand Your Deductible: Know how your insurance plan’s deductible impacts prescription costs.
2. Explore Patient Assistance Programs: Many pharmaceutical companies offer programs to help cover costs.
3. Use Health Savings Accounts (HSAs): Pre-tax dollars can significantly lower your out-of-pocket expenses.
4. Check for Insurance Plan Negotiation Options: Some insurers offer deductible negotiation for specific treatments.
5. Consider Cost-Sharing Reductions (CSRs): For eligible individuals, CSRs can reduce costs before deductibles are met.
6. Look into Preventive Care Designations: Some medications may qualify, affecting deductible application.
7. Plan Around Annual Deductible Resets: Timing your purchases can make a difference in your expenses.
8. Examine Marketplace Plan Options: Different plans offer varying coverage levels and deductible requirements.
9. Investigate Flex Spending Accounts (FSAs): Similar to HSAs but with different rules and benefits.
10. Understand Catastrophic Health Plans: Know your coverage limits and out-of-pocket maximums.
11. Appeal Insurance Denials: If coverage is denied, appealing the decision could result in overturned decisions.

FAQs

How much does Mounjaro cost per month?

The cost can vary widely depending on your insurance coverage, pharmacy, and eligibility for assistance programs.

How do you get Mounjaro covered?

Start by consulting with your insurance provider to understand your plan’s coverage. Explore patient assistance programs and discuss alternatives with your healthcare provider.

Why is Mounjaro not covered by insurance?

Coverage depends on your specific plan and its formulary. Some plans may not cover Mounjaro if there are cheaper alternatives available.

How much does Mounjaro cost at Walgreens?

Prices can differ by location and insurance. Contacting Walgreens directly or checking through their online pharmacy with your insurance details will provide the most accurate cost.

Conclusion

As we look towards the future of healthcare and prescription drug coverage, it’s clear that medications like Mounjaro play a crucial role in managing chronic conditions. However, the financial aspect of these treatments cannot be overlooked. By staying informed about your insurance options, leveraging saving accounts, and exploring assistance programs, managing the costs of necessary medications becomes a more navigable journey.

For more information on managing healthcare costs and understanding insurance coverage, contact us here.

References

• Healthcare.gov. “Understanding Health Insurance.” https://www.healthcare.gov/
• Mounjaro Patient Assistance Program. https://www.mounjaro.com/patient-assistance-program
• Health Savings Account (HSA) Information. https://www.hsacenter.com/