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Care 33 , 643649 (2017)

metformin and at least one other GLP-1 typically required first Manufacturer list price / $1,023 per month TRICARE copay range / $77 to $334 depending on plan type and pharmacy Appeal pathway / Written appeal to regional TRICARE contractor (typically within 90 days) Manufacturer savings card / Generally cannot be combined with TRICARE (federal insurance restriction) FDA-approved indication / Type 2 diabetes mellitus in adults TRICARE Formulary Placement for Mounjaro TRICARE places Mounjaro (tirzepatide) on its non-preferred specialty formulary tier, which carries higher cost-sharing than preferred brands

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