UPMC Health Plan Coverage for Mounjaro

8 Plans

Managed Medicaid - HMO - Medicaid

$$$$$
Non-preferred
PA requirements
Quantity Limit

Medicare - MA-PD

$$$$$
Preferred
PA requirements
Quantity Limit

Medicare - PDP

$$$$$
Preferred
PA requirements
Quantity Limit

Commercial - HMO

$$$$$
Preferred
PA requirements
Step therapies
Quantity Limit

Commercial - PPO

$$$$$
Preferred
PA requirements
Step therapies
Quantity Limit

Commercial - Other Insurer

$$$$$
Preferred
PA requirements
Step therapies
Quantity Limit

Commercial - Employer

$$$$$
Preferred
PA requirements
Step therapies
Quantity Limit

Health Exchange - PPO-HIX

$$$$$
Preferred
PA requirements
Step therapies
Quantity Limit