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Veteran's Mounjaro criteria and copay worksheet
Go through the VA's April 2026 Mounjaro exclusions with your prescriber, mark which additional criterion fits, note your eye exam date, and keep a record of each fill's copay against the yearly cap.
Exclusions to go through with your VA prescriber
Some of these can still be considered when the risks are discussed and a monitoring plan is written into your record.
- Medullary thyroid cancer or MEN 2, in you or your family
- Pregnancy, or planning a pregnancy
- Past pancreatitis, and whether its cause is known
- Taking sitagliptin, saxagliptin, linagliptin or another DPP-4 inhibitor
- Severe gastroparesis or other slow stomach emptying
- Diabetic retinopathy or macular edema
- Low body weight or loss of muscle (sarcopenia)
Which additional criterion fits
Heart, vessel or kidney disease on record, and why empagliflozin is not a good fit
Empagliflozin and metformin: doses, dates, and glucose results
Or the medicine Mounjaro would replaceinsulin, a sulfonylurea, a DPP-4 inhibitor or pioglitazone
Date and result of the last diabetic eye exam
From the VA's April 2026 Criteria for Use
- Any listed exclusion means the criteria are not met; individual exceptions are decided at the local facility.[1]
- One additional criterion is required: ASCVD or CKD without being a good candidate for empagliflozin, goals unmet on empagliflozin plus maximally tolerated metformin, or replacing another diabetes medicine.[1]
- CKD here means eGFR below 60 or a urine albumin-to-creatinine ratio of 30 mg/g or more.[1]
- A diabetic eye exam from the past 12 months should be on file before a GLP-1 agonist is considered.[1]
- For weight management, the document points to the VA's separate weight management criteria.[1]
VA copay rules for 2026
- Mounjaro's VA Formulary Advisor record lists copay tier 3.[2]
- Tier 3 (brand-name) copays are $11, $22 and $33 for 1 to 30, 31 to 60 and 61 to 90 day supplies.[3]
- Medication copays stop for the calendar year once $700 has been charged.[3]
Fill and copay record
| Fill date | Strength | Days of supply | Copay billed | Year-to-date copays |
|---|---|---|---|---|
Questions for your VA team
- Which criterion is my request being reviewed under, and is anything missing from my record?
- Is my diabetes rated as service-connected, and does that change my copay?
- Should I give VA my income information to check for free medications?
- Will my fills come by mail from a VA pharmacy, and how far ahead should I reorder?
- If I am also using Mounjaro for weight, which VA criteria apply instead?
Sources for the facts on this sheet
- VA Pharmacy Benefits Management Services and National Formulary Committee. Tirzepatide (MOUNJARO) Injection for Type 2 Diabetes Mellitus: Criteria for Use, April 2026. Accessed 2026-10-18. https://www.va.gov/formularyadvisor/DOC_PDF/CFU_Tirzepatide_MOUNJARO_Criteria_in_Type_2_Diabetes_April_2026.pdf
- U.S. Department of Veterans Affairs, VA Formulary Advisor (data file). VA Formulary Advisor national formulary data file: tirzepatide injection (Mounjaro) record. Accessed 2026-10-18. https://www.va.gov/formularyadvisor/VANF.json
- U.S. Department of Veterans Affairs. Current VA Health Care Copay Rates. Accessed 2026-10-18. https://www.va.gov/health-care/copay-rates/
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.