Summary
This guide outlines the prior authorization (PA) process for Mounjaro, an injectable medication indicated for improving glycemic control in adults with type 2 diabetes mellitus. It details the limitations of use, including contraindications for patients with a history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). The document emphasizes the importance of providing accurate information during the PA submission process, which may require specific ICD-10-CM diagnosis codes and details about the patient's treatment history and medical background. It also includes examples of diagnosis codes relevant for type 2 diabetes and highlights the necessity of reviewing individual payer guidance to ensure appropriate documentation is submitted. Additionally, the guide addresses potential risks associated with Mounjaro, including thyroid tumors, pancreatitis, and gastrointestinal adverse reactions, and advises on monitoring and patient counseling regarding these risks.
