Successful Starts
Ms. Webber:
Hi! I’m Dana Webber, and I’m a nurse practitioner in Knoxville, Tennessee.
Today I’m excited to share my clinical experience and offer some tips to help you and your appropriateatients with type 2 diabetes have successful starts with Mounjaro.
Before we jump in, let’s review the Indication and Boxed Warning for Mounjaro.
Mounjaro is indicated as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus.
Warning: Risk of Thyroid C-cell Tumors
In both male and female rats, tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether Mounjaro causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of tirzepatide-induced rodent thyroid C-cell tumors has not been determined.
Mounjaro is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk for MTC with the use of Mounjaro and inform them of symptoms of thyroid tumors (for example, a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Mounjaro.
Let’s dive in. After discussing the potential risks and benefits together, you and your patient have decided to start Mounjaro alongside diet and exercise. So, what’s next?
Designed with the patient in mind, the Mounjaro pen is a single-use, once-weekly, auto-injection pen with a hidden needle. To start your patients on Mounjaro, first initiate with the 2.5-milligram dose once weekly. The 2.5-milligram dose is for treatment initiation and is not intended for glycemic control. After 4 weeks on the 2.5-milligram dose, increase to the 5-milligram dose once weekly.
For the initial prescription, you can provide your patient with both a 1-month 2.5-milligram prescription and up to a 3-month 5-milligram prescription.
Another key part of this journey is preparing your patient to start their Mounjaro treatment. Be sure to instruct your patients on the dosage and administration of Mounjaro, including how to correctly inject their dose. If you have them in your office, demo pens or samples can help guide these conversations. I like to show a patient how to use Mounjaro with a demo pen, and then ask them to repeat the process back to me to ensure they understand. You may also want to consider having your adult patient administer their first 2.5-milligram dose in your office.
In my experience, having these initial conversations is critical to set expectations about potential adverse events, mitigate concerns, and answer any questions the patient may have.
There are also many resources available for patients as they begin Mounjaro, including the digital starter kit, patient brochure, and Lilly Health™ app. These are tools that your patient can continue to refer to after they leave your office.
It’s important to remember that your patient is about to begin a new step in their treatment journey. So, be patient and provide them with the information they need to understand their treatment and how to ensure a successful start with Mounjaro.
You may be thinking, “Dana, that’s all great. I know how to dose Mounjaro and prep my patient, but is there anything I can do to help my patient obtain Mounjaro after I prescribe it?”
Well, Mounjaro has 92% commercial and Part D market access nationally. And savings may be available to get your eligible, commercially insured patients with Mounjaro coverage started. Patients can experience Mounjaro for as little as $25 for up to a 3-month prescription. Note, governmental beneficiaries are excluded, and terms and conditions apply. You can visit the Mounjaro HCP website to review the full terms and conditions.
You can also find coverage and savings-related information, including personalized formulary coverage based on your NPI number and zip code, on the Mounjaro website.
At times, the patient’s health plan may require a prior authorization, or PA, before covering Mounjaro.
Did you know that the PA process for Mounjaro is consistent with the process for other incretin-based therapies like Ozempic®?
While completing a PA may require some additional work, to me it’s worth the effort. I am motivated to help my patients, and often that means communicating their individual stories and medical histories in the form of PA.
When submitting a PA, it is important to provide the correct information to help ensure there are no delays in treatment. Some common reasons a PA may get denied include an off-label diagnosis, lack of the full A1C history for the patient, and incomplete documentation, such as missing specific ICD-10-CM codes.
So, whenever you or your staff are filling out a PA, ensure a correct diagnostic code for type 2 diabetes is included. Some example ICD-10-CM codes for type 2 diabetes include E11.65, E11.8, and E11.9.
While payer and health plan requirements can vary, PA submission forms also often request information about the patient’s treatment and medical history. As a best practice, aim to include detailed account of the patient’s medical history and treatment, like starting and recent A1C levels, documentation of other comorbid conditions, and previous therapies.
In the event that you need to fill out a PA for your patient, you may be able to start a PA request in just 4 steps at CoverMyMeds.com. It can also help you maintain communication with your patients throughout the process, as many patients appreciate hearing updates on the status of their PAs. Using CoverMyMeds for PAs also gives healthcare providers the ability to notify patients of their PA outcome in real time via text or email.
While I handle PA submissions myself, I know many providers rely on others in their office to assist with these requests. So, it is important to check in with your staff from time to time to hear about their experiences securing coverage of Mounjaro for your patients with type 2 diabetes. You may be surprised by what you hear!
Once your adult patients have begun their treatment, keep in mind that there are multiple doses of Mounjaro available for customizable glycemic control. So be sure to follow up with your patients to assess progress toward meeting their individual needs.
If additional glycemic control is needed, you can continue to increase the dose by 2.5-milligram increments after at least 4 weeks on current dose. The maximum dose is 15 milligrams once weekly for adult patients, and the recommended dosage escalation should be followed to reduce the risk of gastrointestinal adverse reactions.
With that, I hope these tips help you get your appropriate patients with type 2 diabetes started with Mounjaro. I encourage you to use the various resources available to you and your patients on the Mounjaro website. You can scan this QR code to access them.
Thank you for listening today! I hope you leave here with the confidence to help your patients have successful starts with Mounjaro.
Select Important Safety Information for Mounjaro (tirzepatide)
Contraindications: Mounjaro is contraindicated in patients with a personal or family history of MTC or in patients with MEN 2, and in patients with known serious hypersensitivity to tirzepatide or any of the excipients in Mounjaro. Serious hypersensitivity reactions including anaphylaxis and angioedema have been reported with Mounjaro.
Risk of Thyroid C-cell Tumors: Counsel patients regarding the potential risk for MTC with the use of Mounjaro and inform them of symptoms of thyroid tumors (for example, a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Mounjaro. Such monitoring may increase the risk of unnecessary procedures, due to the low test specificity for serum calcitonin and a high background incidence of thyroid disease. Significantly elevated serum calcitonin values may indicate MTC and patients with MTC usually have calcitonin values >50 ng/L. If serum calcitonin is measured and found to be elevated, the patient should be further evaluated. Patients with thyroid nodules noted on physical examination or neck imaging should also be further evaluated.
Acute Pancreatitis: Acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with GLP-1 receptor agonists, or Mounjaro. Observe patients for signs and symptoms, including persistent or severe abdominal pain sometimes radiating to the back, which may or may not be accompanied by nausea or vomiting. If pancreatitis is suspected, discontinue Mounjaro and initiate appropriate management.
Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin: Concomitant use with an insulin secretagogue (for example, sulfonylurea) or insulin may increase the risk of hypoglycemia, including severe hypoglycemia. The risk of hypoglycemia may be lowered by reducing the dose of sulfonylurea (or other concomitantly administered insulin secretagogue) or insulin. Inform patients using these concomitant medications of the risk of hypoglycemia and educate them on the signs and symptoms of hypoglycemia.
Hypersensitivity Reactions: Serious hypersensitivity reactions (for example, anaphylaxis and angioedema) have been reported in patients treated with Mounjaro. If hypersensitivity reactions occur, discontinue use of Mounjaro; treat promptly per standard of care, and monitor until signs and symptoms resolve. Do not use in patients with a previous serious hypersensitivity to tirzepatide or any of the excipients in Mounjaro. Use caution in patients with a history of angioedema or anaphylaxis with a GLP-1 receptor agonist because it is unknown if such patients will be predisposed to these reactions with Mounjaro.
Acute Kidney Injury Due to Volume Depletion: There have been postmarketing reports of acute kidney injury, in some cases requiring hemodialysis, in patients treated with GLP-1 receptor agonists, or Mounjaro. The majority of reported events occurred in patients who experienced gastrointestinal adverse reactions leading to dehydration such as nausea, vomiting, or diarrhea. Monitor renal function in patients reporting adverse reactions to Mounjaro that could lead to volume depletion, especially during dosage initiation and escalation of Mounjaro.
Severe Gastrointestinal Adverse Reactions: Use of Mounjaro has been associated with gastrointestinal adverse reactions, sometimes severe. In the pool of placebo-controlled trials in adults, severe gastrointestinal adverse reactions occurred more frequently among patients receiving Mounjaro (5 mg 1.3%, 10 mg 0.4%, 15 mg 1.2%) than placebo (0.9%). Severe gastrointestinal adverse reactions have also been reported postmarketing with GLP-1 receptor agonists. Mounjaro is not recommended in patients with severe gastroparesis.
Diabetic Retinopathy Complications in Patients with a History of Diabetic Retinopathy: Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy. Mounjaro has not been studied in patients with non-proliferative diabetic retinopathy requiring acute therapy, proliferative diabetic retinopathy, or diabetic macular edema. Patients with a history of diabetic retinopathy should be monitored for progression of diabetic retinopathy.
Acute Gallbladder Disease: In placebo-controlled clinical trials in adults, acute gallbladder disease was reported by 0.6% of Mounjaro-treated patients and 0% of placebo-treated patients. If cholelithiasis is suspected, gallbladder diagnostic studies and appropriate clinical follow-up are indicated.
Pulmonary Aspiration During General Anesthesia or Deep Sedation: Mounjaro delays gastric emptying. There have been rare postmarketing reports of pulmonary aspiration in patients receiving GLP-1 receptor agonists undergoing elective surgeries or procedures requiring general anesthesia or deep sedation who had residual gastric contents despite reported adherence to preoperative fasting recommendations. Instruct patients to inform healthcare providers prior to any planned surgeries or procedures if they are taking Mounjaro.
Adverse Reactions in Adults: The most common adverse reactions reported in ≥5% of Mounjaro-treated patients in placebo-controlled trials were nausea, diarrhea, decreased appetite, vomiting, constipation, dyspepsia, and abdominal pain.
Drug Interactions: When initiating Mounjaro, consider reducing the dose of concomitantly administered insulin secretagogues (such as sulfonylureas) or insulin to reduce the risk of hypoglycemia. Mounjaro delays gastric emptying, and thereby has the potential to impact the absorption of concomitantly administered oral medications, so caution should be exercised.
Pregnancy: Limited data on Mounjaro use in pregnant women are available to inform on drug-associated risk for major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Based on animal reproduction studies, there may be risks to the fetus from exposure to tirzepatide. Use only if potential benefit justifies the potential risk to the fetus.
Lactation: In a single-dose clinical lactation study, the concentration of tirzepatide in breast milk was found to be either undetectable or low compared to the maternal administered dose. There are no available data on the effects of tirzepatide on the breastfed infant or on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Mounjaro and any potential adverse effects on the breastfed infant from Mounjaro or from the underlying maternal condition.
Females of Reproductive Potential: Advise females using oral hormonal contraceptives to switch to a non-oral contraceptive method or add a barrier method of contraception for 4 weeks after initiation and for 4 weeks after each dose escalation.
Pediatric Use: Adverse reactions reported in pediatric patients 10 years of age and older treated with Mounjaro were similar to those reported in adults with the exception of a higher incidence of vomiting, abdominal pain, and hypoglycemia. The safety and effectiveness of Mounjaro have not been established and use is not recommended in patients less than 10 years of age.
Please see the Full Prescribing Information, including Boxed Warning about possible thyroid tumors, including thyroid cancer, and Medication Guide by clicking the links within www.mounjaro.lilly.com/hcp.
Please see Instructions for Use included with the pen.
TR HCP ISI 19DEC2025
CMAT-02256 03/2026 ©Lilly USA, LLC 2026. All rights reserved.