Does Nebraska Total Care, INC. require prior authorization for Mounjaro?
Nebraska Total Care, INC. requires prior authorization for Mounjaro on every Medicare Part D plan of theirs that covers it.
Every plan from this payer that covers the drug requires authorization before it is dispensed.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| 0.5 ML tirzepatide 10 MG/ML Auto-Injector [Mounjaro]2601746 | 3 / 6 | 3 | 0 | 3 | Prior authorization required |
| 0.5 ML tirzepatide 30 MG/ML Auto-Injector [Mounjaro]2601758 | 3 / 6 | 3 | 0 | 3 | Prior authorization required |
| 0.5 ML tirzepatide 5 MG/ML Auto-Injector [Mounjaro]2601764 | 3 / 6 | 3 | 0 | 3 | Prior authorization required |
| 0.5 ML tirzepatide 20 MG/ML Auto-Injector [Mounjaro]2601770 | 3 / 6 | 3 | 0 | 3 | Prior authorization required |
| 0.5 ML tirzepatide 25 MG/ML Auto-Injector [Mounjaro]2601776 | 3 / 6 | 3 | 0 | 3 | Prior authorization required |
| 0.5 ML tirzepatide 15 MG/ML Auto-Injector [Mounjaro]2601785 | 3 / 6 | 3 | 0 | 3 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 0.5 ML tirzepatide 10 MG/ML Auto-Injector [Mounjaro]
Mounjaro has 6 products in the corpus; this table is for 0.5 ML tirzepatide 10 MG/ML Auto-Injector [Mounjaro], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Wellcare Giveback (HMO-POS) | H1215-003 | 3 | Yes | No | Yes |
| Wellcare Simple (HMO-POS) | H1215-005 | 3 | Yes | No | Yes |
| Wellcare Simple Open (PPO) | H1395-002 | 3 | Yes | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Mounjaro at other payers
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.