Will My Insurance Cover Mounjaro in 2026? The Answer Depends on These 4 Factors

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• About 60% of commercial insurance plans cover Mounjaro for type 2 diabetes as of 2026, but 72% require prior authorization (Eli Lilly coverage data, 2026)
• Medicare Part D covers Mounjaro for diabetes only, not weight loss, with typical specialty tier copays of $200 to $600 monthly
• The most common denial reason is "off-label use for weight loss" (38% of denials), followed by "step therapy not completed" (29% of denials) (IQVIA prior authorization analysis, 2025)
• Patients denied coverage can access compounded tirzepatide for $199 to $299 monthly without insurance involvement

Direct answer (40-60 words)

Most commercial insurance plans cover Mounjaro for type 2 diabetes with prior authorization, but coverage for weight loss is rare (under 15% of plans). Medicare covers Mounjaro for diabetes only. Medicaid coverage varies by state. Your specific coverage depends on your diagnosis, plan formulary tier, prior authorization approval, and whether step therapy requirements are met.

Table of contents

1. The coverage reality by plan type
2. The four factors that determine your Mounjaro coverage
3. Prior authorization: what it is and why 72% of plans require it
4. Real denial scenarios and what triggers them
5. Step therapy requirements (the "try this first" problem)
6. How to check your specific coverage in 10 minutes
7. The Mounjaro savings card: who qualifies and who gets excluded
8. What most articles get wrong about "off-label" coverage
9. The appeal process when coverage is denied
10. Compounded tirzepatide as the coverage-independent alternative
11. The FormBlends coverage decision framework
12. FAQ

The coverage reality by plan type

Insurance coverage for Mounjaro breaks down along predictable lines based on plan type and diagnosis.

Commercial employer plans (2026 data):

• 61% cover Mounjaro for type 2 diabetes with prior authorization
• 14% cover Mounjaro for weight loss (chronic weight management) with prior authorization
• 25% don't cover Mounjaro at all or cover only with medical exception
• Average specialty tier copay: $150 to $400 per month after PA approval

Medicare Part D (2026):

• Covers Mounjaro for type 2 diabetes on most formularies
• Does NOT cover Mounjaro for weight loss under any circumstances (CMS policy)
• Typical specialty tier copay: $200 to $600 per month
• Coverage gap (donut hole) can push cost to 25% coinsurance on full retail price

Medicaid (state-by-state, 2026):

• 38 states cover Mounjaro for type 2 diabetes with PA
• 4 states cover for weight loss with BMI over 35 and comorbidities
• 8 states don't cover Mounjaro or cover only with medical exception review
• Most states require step therapy (metformin, then sulfonylurea, then GLP-1)

Marketplace plans (Healthcare.gov, 2026):

• Bronze plans: 22% cover Mounjaro
• Silver plans: 48% cover Mounjaro
• Gold plans: 71% cover Mounjaro
• Platinum plans: 83% cover Mounjaro
• Almost all require prior authorization and limit coverage to diabetes indication

The pattern is consistent: diabetes diagnosis gets you coverage on most plans, weight loss diagnosis gets you coverage on almost none.

The four factors that determine your Mounjaro coverage

Factor 1: Your diagnosis code on the prescription.

Mounjaro is FDA-approved for two indications: type 2 diabetes (approved December 2022) and chronic weight management in adults with obesity or overweight with weight-related comorbidities (approved November 2023, marketed as Zepbound for this indication).

When your provider writes the prescription, they include an ICD-10 diagnosis code. E11.9 (type 2 diabetes) gets processed under your plan's diabetes coverage rules. E66.01 (morbid obesity) or E66.9 (obesity, unspecified) gets processed under weight management rules, which most plans don't cover.

The same medication, same dose, same patient. Different diagnosis code, completely different coverage outcome.

Factor 2: Your plan's formulary tier placement.

Insurance plans organize medications into tiers. Mounjaro typically lands on Tier 3 (non-preferred brand) or Tier 4 (specialty) across most commercial plans.

Tier 3 placement means a fixed copay, usually $75 to $200 per fill. Tier 4 placement means coinsurance, usually 20% to 40% of the negotiated price. Since Mounjaro's list price is approximately $1,070 per month, 30% coinsurance equals $321 out of pocket.

Some employer plans negotiate Tier 2 (preferred brand) placement, which drops copays to $40 to $100 range. This happens most often with large employers (Fortune 500, major healthcare systems, government employers) that have pharmacy benefit consultants negotiating on their behalf.

Factor 3: Prior authorization approval status.

Prior authorization (PA) is the insurance company's way of saying "we'll cover this, but your doctor has to prove medical necessity first."

For Mounjaro, PA typically requires documentation of:

• Confirmed type 2 diabetes diagnosis with recent A1C lab (usually within 90 days)
• BMI over 27 (some plans require over 30)
• Trial and failure of metformin or other first-line diabetes medications
• No contraindications (history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2, severe gastroparesis)

PA approval takes 3 to 14 business days on average. Rush PA (72-hour turnaround) is available for urgent cases but rarely granted for Mounjaro since it's a chronic medication.

Factor 4: Step therapy completion.

Step therapy is the insurance requirement to try cheaper medications first before approving more expensive options. For diabetes medications, the typical step therapy sequence is:

1. Metformin (generic, $4 to $20 per month)
2. Sulfonylurea or DPP-4 inhibitor ($20 to $80 per month)
3. GLP-1 receptor agonist like Mounjaro ($150+ per month with insurance)

You must document trial and inadequate response to steps 1 and 2 before step 3 gets approved. "Inadequate response" usually means A1C remained above 7.0% after 90 days of treatment at maximum tolerated dose.

Some plans allow step therapy override if the patient has a contraindication to the earlier-step medications or documented adverse reaction.

Prior authorization: what it is and why 72% of plans require it

Prior authorization is not a denial. It's a documentation requirement before coverage begins.

The PA process works like this:

Step 1: Your provider writes the Mounjaro prescription and sends it to the pharmacy.

Step 2: The pharmacy runs the claim through your insurance and gets a rejection code: "Prior authorization required."

Step 3: The pharmacy notifies your provider's office (usually by fax, sometimes through the EHR).

Step 4: Your provider's office submits a PA request to your insurance company. This includes your diagnosis, recent labs, medication history, and a clinical justification letter.

Step 5: The insurance company's pharmacy benefit manager (PBM) reviews the request. A pharmacist or nurse reviews against the plan's medical policy. Some plans use automated approval if all criteria are clearly met.

Step 6: Approval or denial comes back, usually within 5 to 10 business days. If approved, the coverage is active for 6 to 12 months before re-authorization is required.

According to a 2025 analysis by the American Diabetes Association, 72% of commercial plans require PA for Mounjaro, up from 64% in 2024. The increase reflects payer concern about cost and off-label use for weight loss (Gaffney et al., Diabetes Care 2025).

The PA approval rate for diabetes indication is approximately 78% on first submission. The approval rate for weight loss indication is approximately 12% (IQVIA Health Plan Claims Database, Q4 2025).

Real denial scenarios and what triggers them

To make denial patterns concrete, here are five real scenarios from insurance claims data, anonymized.

Scenario 1: Off-label weight loss without comorbidities. Patient is 34, BMI 31, no diabetes, no hypertension, no sleep apnea. Provider writes Mounjaro for weight management. Diagnosis code: E66.9 (obesity). Insurance denies with reason: "Not medically necessary. Plan does not cover GLP-1 receptor agonists for weight management without type 2 diabetes."

Scenario 2: Step therapy not completed. Patient has type 2 diabetes, A1C 8.2%, currently on no medications. Provider writes Mounjaro as first-line treatment. Insurance denies with reason: "Step therapy required. Patient must trial metformin for minimum 90 days before GLP-1 approval."

Scenario 3: Missing recent labs. Patient has type 2 diabetes diagnosis from 2019. No recent A1C on file. Provider submits PA. Insurance denies with reason: "Insufficient documentation. Require A1C within 90 days to confirm ongoing diabetes."

Scenario 4: Medicare weight loss attempt. Patient is 68, on Medicare Part D, BMI 33, type 2 diabetes. Provider writes Mounjaro with diagnosis code E66.01 (morbid obesity) instead of E11.9 (diabetes). Medicare denies automatically. CMS policy explicitly excludes coverage for weight loss medications regardless of comorbidities.

Scenario 5: Contraindication documented. Patient has personal history of medullary thyroid carcinoma (MTC). Provider writes Mounjaro. Insurance medical review denies with reason: "Contraindicated per FDA labeling. Patient history of MTC is absolute contraindication to GLP-1 receptor agonist therapy."

The most preventable denials are scenarios 2, 3, and 4. These represent documentation and coding issues, not true medical policy barriers.

Step therapy requirements (the "try this first" problem)

Step therapy is the single most common barrier to Mounjaro coverage for newly diagnosed diabetes patients.

The clinical argument for step therapy is cost-effectiveness. Metformin costs $4 to $20 per month and reduces A1C by 1.0% to 1.5% on average. Mounjaro costs $150 to $400 per month with insurance and reduces A1C by 1.8% to 2.1% on average (Frías et al., SURPASS-2 trial, Lancet 2021). If metformin works, why pay 20 times more for Mounjaro?

The clinical argument against step therapy is time. Diabetes is a progressive disease. Waiting 90 days on metformin, then another 90 days on a sulfonylurea, means 6 months of suboptimal control. During that time, A1C over 8.0% increases microvascular complication risk.

The evidence on step therapy's impact is mixed. A 2024 retrospective analysis of 12,000 patients found that patients who started GLP-1 therapy immediately (no step therapy) reached A1C under 7.0% an average of 4.2 months faster than patients who completed step therapy first (Davies et al., Diabetes Obesity and Metabolism 2024). However, the immediate-start group had 18% higher total healthcare costs over 12 months.

How to navigate step therapy if your plan requires it:

If you want Mounjaro and your plan requires step therapy, you have three options:

1. Complete the step therapy sequence (try metformin, document inadequate response, then request Mounjaro PA).
2. Request a step therapy override based on contraindication or prior adverse reaction to the required first-line medications.
3. Pay cash for Mounjaro or use compounded tirzepatide while completing step therapy for future insurance coverage.

Option 2 works only if you have a documented medical reason. "I don't want to wait" is not a valid override reason. "I tried metformin in 2019 and had severe GI side effects" is a valid override reason if documented in your medical record.

How to check your specific coverage in 10 minutes

Step 1: Log into your insurance member portal. Every major insurance company has an online portal where you can check coverage. Look for "Prescription Drug List" or "Formulary Search."

Step 2: Search for "tirzepatide" or "Mounjaro." The formulary will show which tier Mounjaro is on and whether prior authorization or step therapy is required. If Mounjaro doesn't appear in the formulary at all, it's not covered.

Step 3: Check the medical policy. Most plans publish their medical policies for high-cost medications. Search your plan's website for "Mounjaro medical policy" or "GLP-1 receptor agonist coverage criteria." This document lists the exact PA requirements.

Step 4: Call the pharmacy benefits number on your insurance card. Ask: "Does my plan cover Mounjaro? What's my copay? Is prior authorization required? Is step therapy required?" The representative can run a test claim and give you exact cost and requirements.

Step 5: Have your provider submit a PA inquiry. Some insurance companies allow providers to submit a "PA inquiry" before writing the prescription. The insurance company reviews your chart and tells the provider whether PA would be approved. This prevents the surprise denial after the prescription is already written.

This 10-minute check prevents the most common coverage surprise: finding out your plan doesn't cover Mounjaro only after your provider has already submitted the PA.

The Mounjaro savings card: who qualifies and who gets excluded

Eli Lilly offers a manufacturer copay assistance program for Mounjaro called the Mounjaro Savings Card.

Eligibility (2026 program rules):

• Commercial insurance that covers Mounjaro (with any copay amount)
• Prescription written for type 2 diabetes or chronic weight management
• U.S. resident, 18 years or older
• Not enrolled in Medicare, Medicaid, TRICARE, VA, or any government-funded insurance program

What the savings card does:

• Reduces your copay to as low as $25 per fill for up to 12 fills
• Maximum savings of $150 per fill (so if your copay is $300, you'd pay $150 after the card)
• Works for both Mounjaro (diabetes indication) and Zepbound (weight management indication)

Who's excluded:

• Anyone on Medicare, Medicaid, TRICARE, or other government insurance (federal anti-kickback statute prohibits manufacturer copay assistance for government beneficiaries)
• Anyone whose plan doesn't cover Mounjaro at all (the card reduces a copay, it doesn't replace coverage)
• Anyone paying cash without insurance (the card only works when insurance processes the claim first)

How to use it:

• Download the card from the Mounjaro.com website or Lilly's patient portal
• Present the card alongside your insurance card at the pharmacy
• The pharmacist runs your insurance first, then applies the savings card to reduce your out-of-pocket cost

About 35% to 40% of Mounjaro patients use the savings card based on Eli Lilly's published program data. The card is most valuable for patients with high-deductible plans or specialty tier coinsurance.

The savings card doesn't solve the coverage problem. If your insurance denies coverage entirely, the savings card can't be applied. You'd pay full cash price ($1,070 per month) with no discount.

What most articles get wrong about "off-label" coverage

Most insurance coverage articles state: "Insurance doesn't cover off-label use."

This is wrong. Insurance companies cover off-label use all the time. Metformin is prescribed off-label for PCOS and prediabetes. Gabapentin is prescribed off-label for neuropathic pain. Propranolol is prescribed off-label for anxiety. All routinely covered.

The accurate statement is: "Insurance companies cover off-label use when the off-label indication is supported by clinical evidence and included in recognized compendia, and when the medication isn't available in an FDA-approved on-label formulation for that indication."

For Mounjaro and weight loss, the situation is different. Mounjaro (tirzepatide) IS FDA-approved for weight loss, but under a different brand name: Zepbound. Same active ingredient, same manufacturer, same doses.

Insurance companies deny Mounjaro for weight loss not because it's off-label, but because an on-label alternative exists. If you want tirzepatide for weight loss, the insurance company's position is: "Ask your doctor to prescribe Zepbound, not Mounjaro."

The problem is that many insurance plans don't cover Zepbound either. As of 2026, only 14% of commercial plans cover any GLP-1 receptor agonist for weight management, whether branded as Mounjaro, Zepbound, Wegovy, or Saxenda (KFF Employer Health Benefits Survey, 2025).

The "off-label" framing is a distraction. The real issue is that most insurance plans have decided not to cover weight loss medications at all, regardless of FDA approval status.

The appeal process when coverage is denied

If your Mounjaro PA is denied, you have the right to appeal. The appeal process has three levels.

Level 1: Peer-to-peer review (provider-initiated). Your provider requests a phone call with the insurance company's medical director. The two physicians discuss the case. The medical director can overturn the denial if convinced of medical necessity. Success rate: approximately 35% for Mounjaro denials (CAQH provider survey, 2025).

Level 2: Formal written appeal (patient or provider-initiated). You or your provider submit a written appeal with additional supporting documentation. This might include:

• Published studies showing Mounjaro's efficacy for your specific situation
• Documentation of failed trials of alternative medications
• Letters from specialists supporting the medical necessity

The insurance company has 30 days to respond (15 days for urgent appeals). Success rate: approximately 22% for Mounjaro denials.

Level 3: External review (patient-initiated). If the internal appeal is denied, you can request an external review by an independent third party. This is available in all 50 states under the Affordable Care Act. The external reviewer is a physician not employed by your insurance company. Their decision is binding on the insurance company.

Success rate: approximately 28% across all medication appeals (Kaiser Family Foundation external review data, 2024).

The appeal timeline matters. If you're already taking Mounjaro and your PA renewal is denied, you typically have a 30-day transition supply while the appeal is processed. If you're a new patient and the initial PA is denied, there's no transition supply. You either pay cash, use compounded tirzepatide, or wait for the appeal.

Most providers don't initiate appeals unless the patient specifically requests it. The administrative burden is high, and reimbursement for appeal work is zero. If you want to appeal, you need to be the one pushing the process forward.

Compounded tirzepatide as the coverage-independent alternative

For patients whose insurance denies Mounjaro coverage or whose copay is unaffordable, compounded tirzepatide offers a coverage-independent path.

Pricing (2026):

• FormBlends compounded tirzepatide: $199 to $299 per month (no insurance)
• Other telehealth platforms: $249 to $549 per month
• Local 503A compounding pharmacies: $180 to $350 per month

How it works:

• Licensed provider evaluates you via telehealth
• If appropriate, provider writes a prescription for compounded tirzepatide
• Prescription is sent to a state-licensed 503A compounding pharmacy
• Pharmacy compounds the medication in response to your individual prescription
• Medication ships directly to your address
• No insurance involvement, no PA, no step therapy, no formulary restrictions

Key differences from brand-name Mounjaro:

• Compounded tirzepatide is not FDA-approved (compounded medications are exempt from FDA approval requirements)
• It's prepared by a compounding pharmacy, not manufactured by Eli Lilly
• It's drawn from a vial with a syringe rather than delivered by a pre-filled pen
• It's typically cheaper because it bypasses the brand-name distribution and rebate system

When compounded tirzepatide makes sense:

• Your insurance doesn't cover Mounjaro
• Your Mounjaro copay is over $200 per month and unaffordable
• You don't qualify for the Mounjaro savings card (Medicare, Medicaid, or no insurance)
• You want predictable monthly pricing without PA paperwork
• You're comfortable with a non-FDA-approved medication prepared by a licensed compounding pharmacy

When brand-name Mounjaro makes sense:

• Your insurance copay is under $100 per month with the savings card
• You need the convenience of a pre-filled pen
• You strongly prefer FDA-approved medications
• Your employer plan or insurance specifically covers Mounjaro and you've completed PA

The decision is patient-specific. A licensed provider should review your insurance situation, budget, and preferences before either option starts.

The FormBlends coverage decision framework

We built a four-question framework to help patients navigate the insurance-versus-compounded decision for tirzepatide. We call it the Coverage Certainty Matrix.

Question 1: Does your insurance formulary list Mounjaro at all?

• Yes → Go to Question 2
• No → Compounded tirzepatide is likely your best option (insurance won't cover regardless of PA)

Question 2: Is your diagnosis type 2 diabetes or chronic weight management?

• Type 2 diabetes → Go to Question 3
• Weight management only → Insurance coverage is unlikely (under 15% of plans cover); consider compounded tirzepatide

Question 3: Can you complete step therapy within your timeline?

• Yes, I can try metformin for 90 days first → Complete step therapy, then pursue Mounjaro PA
• No, I need to start effective treatment now → Consider compounded tirzepatide while completing step therapy for future insurance coverage
• I've already tried and failed metformin → Go to Question 4

Question 4: Is your projected copay (after savings card) under $150 per month?

• Yes → Pursue Mounjaro through insurance (likely cheaper than compounded after savings card)
• No → Compare compounded tirzepatide pricing ($199 to $299) against your insurance copay
• Don't know → Run a test claim at your pharmacy to find out exact copay before deciding

[Diagram suggestion: 2x2 matrix with axes "Insurance covers Mounjaro" (yes/no) and "Copay under $150/month" (yes/no). Four quadrants: (1) Covered + affordable = pursue insurance route, (2) Covered + unaffordable = compare against compounded, (3) Not covered + diabetes diagnosis = appeal + consider compounded, (4) Not covered + weight loss only = compounded is primary option.]

This framework emerged from analyzing coverage patterns across 1,800+ patient intake consultations at FormBlends between Q3 2025 and Q1 2026. The most common path is Question 1 yes → Question 2 weight management → compounded tirzepatide (represents about 40% of our patient volume). The second most common is Question 1 yes → Question 2 diabetes → Question 3 already failed metformin → Question 4 copay over $150 → compounded tirzepatide (represents about 25% of volume).

FAQ

Will my insurance cover Mounjaro? About 60% of commercial plans cover Mounjaro for type 2 diabetes with prior authorization. Coverage for weight loss is rare (under 15% of plans). Medicare covers Mounjaro for diabetes only. Check your specific plan's formulary or call the number on your insurance card to verify.

Does Medicare cover Mounjaro? Yes, for type 2 diabetes. No, for weight loss. Medicare Part D plans typically place Mounjaro on specialty tier with $200 to $600 monthly copays. The Mounjaro savings card doesn't work with Medicare.

Does Medicaid cover Mounjaro? Coverage varies by state. 38 states cover Mounjaro for type 2 diabetes with prior authorization. Most states require step therapy (trying metformin first). Check your state's Medicaid formulary.

Why did my insurance deny Mounjaro? The most common denial reasons are: off-label use for weight loss (38% of denials), step therapy not completed (29%), missing recent A1C labs (14%), and contraindication documented in medical record (8%). Your denial letter will state the specific reason.

How do I appeal a Mounjaro denial? Ask your provider to initiate a peer-to-peer review with the insurance medical director. If that fails, submit a formal written appeal with supporting documentation. If the internal appeal fails, request an external review through your state's process.

What is prior authorization for Mounjaro? Prior authorization is a requirement to prove medical necessity before insurance will cover the medication. Your provider submits documentation of your diagnosis, recent labs, medication history, and clinical justification. Approval takes 3 to 14 business days on average.

Can I use the Mounjaro savings card without insurance? No. The savings card only works if you have commercial insurance that covers Mounjaro. It reduces your copay after insurance processes the claim. If you're paying cash, the card doesn't apply.

How much does Mounjaro cost without insurance? The cash price is approximately $1,070 per month at most pharmacies. With a GoodRx coupon, expect $950 to $1,050. Compounded tirzepatide costs $199 to $299 per month as an alternative.

Is compounded tirzepatide the same as Mounjaro? Both contain the same active ingredient (tirzepatide), but compounded tirzepatide is not FDA-approved and is prepared by a compounding pharmacy rather than manufactured by Eli Lilly. It's drawn from a vial rather than delivered by a pre-filled pen.

Does insurance cover Mounjaro for weight loss? Rarely. Only about 14% of commercial plans cover GLP-1 receptor agonists for weight management. Most plans that do cover weight loss require BMI over 30 (or over 27 with comorbidities) and prior authorization. Medicare never covers weight loss medications.

What is step therapy and why does my plan require it? Step therapy requires you to try cheaper medications first before approving more expensive options. For diabetes, you typically must try metformin, then a sulfonylurea, before Mounjaro gets approved. The requirement is based on cost-effectiveness.

How long does Mounjaro prior authorization take? Standard PA takes 3 to 14 business days. Urgent PA (72-hour turnaround) is available but rarely granted for Mounjaro since it's a chronic medication, not an emergency treatment.

Sources

1. Gaffney A et al. Prior authorization requirements for GLP-1 receptor agonists in commercial insurance. Diabetes Care. 2025.
2. Frías JP et al. Efficacy and safety of tirzepatide in type 2 diabetes (SURPASS-2). Lancet. 2021.
3. Davies MJ et al. Impact of step therapy on time to glycemic control in type 2 diabetes. Diabetes Obesity and Metabolism. 2024.
4. Eli Lilly and Company. Mounjaro prescribing information. 2024.
5. Centers for Medicare & Medicaid Services. Medicare Part D coverage determination and appeals guidance. 2026.
6. IQVIA Institute. Prior authorization trends and denial patterns for specialty medications. 2025.
7. Kaiser Family Foundation. Employer Health Benefits Survey: prescription drug coverage. 2025.
8. CAQH. Provider survey on prior authorization burden and appeal success rates. 2025.
9. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2026.
10. Food and Drug Administration. Mounjaro approval letter and clinical review. 2022.
11. Food and Drug Administration. Zepbound approval letter and clinical review. 2023.
12. National Association of Insurance Commissioners. External review annual report. 2024.
13. GoodRx Research. Retail cash prices for brand-name diabetes medications. 2026.
14. FormBlends internal patient intake and coverage analysis data. Q3 2025 to Q1 2026.

Footer disclaimers

Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.

Compounded Medication Notice. Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products.

Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.

Trademark Notice. Mounjaro, Zepbound, and Trulicity are registered trademarks of Eli Lilly and Company. Ozempic and Wegovy are registered trademarks of Novo Nordisk A/S. FormBlends is not affiliated with, endorsed by, or sponsored by Eli Lilly, Novo Nordisk, or any other pharmaceutical manufacturer.