Mounjaro Insurance Coverage, Cost and Alternatives Compared

Which patients the label covers

Mounjaro's label lists two uses: improving blood sugar in adults and children 10 and older with type 2 diabetes, and reducing the risk of cardiovascular death, non-fatal heart attack or non-fatal stroke in adults with type 2 diabetes at high risk. Weight loss is not a labeled Mounjaro use [3].

How tirzepatide compares with semaglutide

SURPASS-2 assigned 1,879 adults with type 2 diabetes on metformin to tirzepatide 5, 10 or 15 mg or semaglutide 1 mg, all once weekly for 40 weeks [1]. A1C fell by 2.01, 2.24 and 2.30 percentage points with tirzepatide versus 1.86 with semaglutide, and weight reductions were greater with tirzepatide [1]. The trial used semaglutide 1 mg only, so it does not speak to other semaglutide doses.

In a separate open-label trial of 751 adults with obesity and no diabetes, maximum tolerated tirzepatide (10 or 15 mg) produced 20.2% weight loss at 72 weeks versus 13.7% with maximum tolerated semaglutide (1.7 or 2.4 mg) [5].

Cardiovascular outcomes compared with dulaglutide

SURPASS-CVOT compared tirzepatide up to 15 mg with dulaglutide 1.5 mg in 13,165 adults with type 2 diabetes and atherosclerotic cardiovascular disease [2]. The composite of cardiovascular death, heart attack or stroke occurred in 12.2% of those taking tirzepatide and 13.1% of those taking dulaglutide; tirzepatide met the trial's criterion for noninferiority but not for superiority [2].

How compounded tirzepatide differs

Compounded tirzepatide is not FDA-approved and is not reviewed for safety, effectiveness or quality before marketing, and FDA has received adverse event reports involving compounded tirzepatide [4]. FDA states that compounded drugs should only be used in patients whose medical needs cannot be met by an FDA-approved drug [4]. FDA restricts compounding of a drug that is essentially a copy of a commercially available product; a prescriber's documented determination that the compounded product contains a change producing a significant difference for an identified patient is an exception [6].

What to watch for

Tirzepatide delays gastric emptying, and the label advises people using oral hormonal contraceptives to switch to a non-oral method or add a barrier method for 4 weeks after starting and for 4 weeks after each dose escalation [3]. With insulin or a sulfonylurea, hypoglycemia risk rises, and the label says a reduction in the insulin or sulfonylurea dose may be necessary when Mounjaro is started [3].