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What payers require for Mounjaro prior authorization For Mounjaro (diabetes indication), most payers require: Confirmed type 2 diabetes diagnosis with recent HbA1c level (typically above 7.0%) Documentation of current diabetes medications and their inadequacy (most plans require failure of metformin unless contraindicated) Step therapy documentation showing the patient has tried first-line agents before progressing to tirzepatide Prescriber specialty (some plans restrict initial prescribing to endocrinologists or require specialist consultation) The PA request uses the tirzepatide dosing schedule as part of the clinical rationale
The ICD-10 code for iron deficiency anemia is D50.9 for unspecified iron deficiency anemia, effective October 1, 2025 through September 30, 2026 under the FY2026 ICD-10-CM code set
It is not approved by the Therapeutic Goods Administration for human therapeutic use and is not a registered medicine
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