Mounjaro (tirzepatide) is one of the most expensive drugs on any Medicare Part D formulary, and there is no single Medicare price the way there is a fixed Part B fee schedule for a doctor visit. What you pay in 2026 depends on your specific plan's formulary tier, your progress through the deductible and coinsurance phases, and a fast-moving federal pricing deal that has not yet reached most Medicare beneficiaries.
This guide breaks down what standard Medicare Part D charges for Mounjaro in 2026, explains the new $245 Most Favored Nation pricing deal and why it does not yet apply to most people taking Mounjaro for diabetes, and covers self-pay options if your plan's price is too high. For the coverage rules themselves, see does Medicare cover Mounjaro. For the full cash price breakdown, see Mounjaro cost without insurance.
Coverage Breakdown
| Payment Path | 2026 Medicare Price for Mounjaro | How It Works | Notes |
|---|---|---|---|
| Original Medicare (Parts A/B) alone | No price set | Parts A and B do not cover self-injected outpatient drugs | You need a Part D plan for any Mounjaro price at all |
| Standalone Part D plan (diabetes diagnosis) | Varies, capped at $2,100 | Tier 4 or 5 specialty cost-sharing; deductible up to $615, then 25% coinsurance to the 2026 out-of-pocket cap | Most enrollees reach the $2,100 cap within 2 to 4 fills, then pay $0 |
| Medicare Advantage with Part D (MAPD) | Varies by plan | Same 2026 out-of-pocket cap applies; plan sets its own tier and negotiated net price | Compare plans at Medicare.gov Plan Finder by entering Mounjaro directly |
| Extra Help / Low-Income Subsidy | $5.10 to $12.65 | Reduces per-fill cost for qualifying low-income beneficiaries | 2026 full-subsidy caps: $5.10 generic, $12.65 brand-name per fill |
| $245 MFN price / BALANCE Model | Not yet active for Part D | Sets a $245 net price with $50 to $125 copay tiers for Mounjaro under a demonstration model | Medicaid track starts May 2026; Medicare Part D implementation delayed indefinitely as of April 2026 |
| Self-pay (no Medicare involved) | $499 flat (LillyDirect) | LillyDirect self-pay price for any Mounjaro dose; cannot combine with Medicare | Retail list price without any discount is about $1,070 to $1,080 per month in 2026 |
Medicare Part D does not publish one fixed drug price the way Medicare Part B publishes a physician fee schedule. Each Part D and Medicare Advantage plan negotiates its own net price with the manufacturer through a pharmacy benefit manager, and your cost also depends on where you are in the 2026 deductible, coinsurance, and $2,100 out-of-pocket cap structure created by the Inflation Reduction Act of 2022.
Source: CMS 2026 Medicare Advantage and Part D Rate Announcement, CMS Medicare GLP-1 Bridge, KFF BALANCE Model Brief 2026
Direct Answer: What Is the 2026 Medicare Price for Mounjaro?
It depends. Medicare Part D sets no single nationwide price for Mounjaro (tirzepatide). Your monthly cost depends on your plan's formulary tier, the 2026 deductible, and how close you are to the $2,100 annual out-of-pocket cap. Tier-4 or tier-5 cost-sharing typically runs $40 to several hundred dollars a month until you hit that cap, then Mounjaro costs $0 for the rest of 2026. A new federal deal promises $245 pricing, but it has not reached standard Part D plans yet.
What Standard Medicare Part D Charges for Mounjaro in 2026
Original Medicare, meaning Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) together, does not cover Mounjaro at all because it is a self-injected outpatient drug. Medigap supplemental policies do not add drug coverage either, since Medigap only helps with Part A and Part B cost-sharing. Any price for Mounjaro only exists once you are enrolled in Medicare Part D, either a standalone Prescription Drug Plan (PDP) or a Medicare Advantage plan with drug coverage (MAPD). Most 2026 Part D plans place Mounjaro on tier 4 or tier 5, the specialty tiers reserved for the highest-cost drugs.
The 2026 standard Part D benefit works in phases. First, you pay up to the full negotiated price toward the standard $615 deductible, if your plan applies one. After the deductible, you pay 25% coinsurance on covered brand drugs, including Mounjaro, until your total out-of-pocket spending reaches $2,100 for the year, the cap set under the Inflation Reduction Act of 2022. Because Mounjaro's list price is roughly $1,070 to $1,080 a month, many beneficiaries hit the $2,100 cap within 2 to 4 fills and then pay $0 for the drug for the rest of 2026.
The New $245 Medicare Pricing Deal for Mounjaro: What It Actually Covers
In November 2025, the Trump administration announced a Most Favored Nation (MFN) pricing agreement with Eli Lilly that sets a $245 monthly net price for injectable tirzepatide (Mounjaro and Zepbound) sold to Medicare, with beneficiaries paying no more than a $50 copay. That pricing structure is real, but it is not yet the price most Medicare beneficiaries pay for Mounjaro in 2026.
The $245 pricing is built into two separate programs. The Medicare GLP-1 Bridge, running July 1, 2026 through December 31, 2027, covers weight-loss-only GLP-1 drugs (Wegovy, Foundayo, and the Zepbound KwikPen) at a flat $50 copay, but it specifically excludes people with type 2 diabetes, who must use standard Part D coverage instead, meaning Mounjaro is not part of the Bridge. The BALANCE Model, the follow-on program that does include Mounjaro alongside Ozempic and Wegovy, began for state Medicaid programs in May 2026, but CMS delayed its Medicare Part D implementation indefinitely as of April 2026.
What Medicare Advantage Plans May Charge for Mounjaro (2026)
Medicare Advantage plans with drug coverage (MAPD) must follow the same 2026 federal cost-sharing structure and $2,100 out-of-pocket cap as standalone Part D plans, but each plan negotiates its own net price with Eli Lilly through its pharmacy benefit manager and sets its own formulary tier for Mounjaro. Some 2026 MAPD plans place Mounjaro on a preferred specialty tier with lower coinsurance than the standard 25%, which can meaningfully lower what you pay per fill before reaching the annual cap.
During Medicare's Annual Enrollment Period (October 15 through December 7, 2026), you can compare every 2026 MAPD and standalone Part D plan in your ZIP code at Medicare.gov's Plan Finder by entering Mounjaro directly and reviewing the estimated annual cost each plan shows. Coverage under a new plan begins January 1, 2027.