Medicare Part D covers Trulicity, but your out-of-pocket cost depends on which plan you have and which tier the drug sits on

Trulicity (dulaglutide) is a once-weekly injectable medication for type 2 diabetes. Medicare Part D — the prescription drug benefit — covers it at most plans, but you will pay a copay or coinsurance. The amount you pay depends on your specific plan's formulary, which is the list of drugs it covers and at what cost level. Some plans place Trulicity on a higher tier, meaning you pay more. Others negotiate lower costs. You need to check your own plan's formulary to know your exact cost.

Medicare Part A and Part B do not cover Trulicity. Only Part D covers prescription drugs. If you have Original Medicare (Part A and B) without a Part D plan, you are not covered unless you enroll in a standalone Part D plan or switch to a Medicare Advantage plan that includes drug coverage.

Key Takeaways

  • Trulicity is covered by Medicare Part D at most plans, but your cost depends on which plan you chose and what tier the drug is on.
  • You must have Part D coverage — Original Medicare alone does not cover prescription drugs.
  • You can find your plan's formulary on your insurance card, your plan's website, or by calling the customer service number on your card.
  • If Trulicity is too expensive on your current plan, you may be able to switch plans during the annual enrollment period or request a coverage exception from your plan.

How to find out what your plan charges for Trulicity

Your Medicare Part D plan publishes a formulary — a document listing every drug it covers and the cost tier for each one. Tiers usually range from 1 to 5, with tier 1 being the cheapest and tier 5 the most expensive. Trulicity typically lands on tier 2 or 3, but this varies by plan.

To find your plan's formulary, start with your insurance card. It has your plan name and a customer service phone number. Call that number and ask: "What tier is Trulicity on, and what is my copay or coinsurance for that tier?" The representative can tell you in minutes. You can also visit your plan's website and search the formulary directly — most plans have a searchable drug database.

Write down not just the tier, but your actual out-of-pocket cost. Some plans charge a flat copay ($15, $25, $50). Others charge coinsurance, which is a percentage of the drug's cost (usually 20 to 25 percent). Coinsurance means your cost can change if the pharmacy price changes.

What happens if Trulicity is on a higher tier or not covered at all

A small number of Part D plans do not cover Trulicity at all, or place it on a tier so high that the cost is not realistic for you. If that is your situation, you have options.

First, ask your doctor whether a different diabetes medication on your plan's formulary might work for you. Your plan's formulary lists alternatives — often other GLP-1 drugs or older diabetes medications that are cheaper. Your doctor can tell you whether switching is medically reasonable.

Second, you can request a coverage exception from your plan. This is a formal request asking the plan to cover the drug anyway, or to move it to a lower tier. Your doctor must submit this request and explain why Trulicity is medically necessary for you — for example, because you have tried other drugs and they did not work, or because you have a condition that makes Trulicity the safest choice. The plan usually decides within 72 hours. Not all requests are approved, but it costs nothing to ask.

Third, if you are unhappy with your plan's coverage, you can switch to a different Part D plan during the annual enrollment period (October 15 to December 7 each year). You can compare plans side by side to see which ones cover Trulicity at the lowest cost.

The donut hole and how it affects your Trulicity cost

Medicare Part D has a coverage gap called the "donut hole." Once you and your plan have spent a certain amount on drugs in a calendar year, you enter the donut hole and your costs jump. In 2024, the donut hole begins after you have spent $5,850 out of pocket. Once you hit that threshold, you pay a higher percentage of the drug cost until you reach the catastrophic coverage level (around $7,050 out of pocket).

Trulicity is an expensive drug, so if you use it regularly, you may hit the donut hole. When you do, your copay or coinsurance goes up. However, manufacturers often offer copay information cards that help cover costs in the donut hole. Eli Lilly, which makes Trulicity, has a patient information program. Ask your pharmacy or doctor whether you may have access to.

Medicare Advantage plans and Trulicity coverage

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, drug coverage works differently. Medicare Advantage plans are required to cover at least as many drugs as Original Medicare Part D does, but each plan sets its own formulary and costs. Some Advantage plans cover Trulicity at a lower cost than standalone Part D plans; others charge more.

To find out what your Advantage plan charges for Trulicity, call the customer service number on your plan card or visit the plan's website and search the formulary. The process is the same as with Part D — ask for the tier and your copay or coinsurance amount.

What to ask your doctor about Trulicity and cost

Before your doctor prescribes Trulicity, tell them what your Medicare plan charges for it. Ask: "If my copay is high, are there other diabetes medications that work similarly but cost less on my plan?" Your doctor may have samples of Trulicity to give you while you sort out coverage, or they may recommend a different first-line drug that your plan covers more cheaply.

Also ask your doctor whether they can help you request a coverage exception if Trulicity is not covered or is on a high tier. Your doctor's office often handles this paperwork, and their medical reasoning carries weight with the insurance company.

When to contact Medicare directly

If your Part D plan denies a coverage exception or you believe the plan made an error, you have the right to appeal. Contact Medicare at 1-800-MEDICARE (1-800-633-4227) to ask about the appeals process. You can also file a complaint with Medicare if you think your plan is not following its own rules.

Medicare also has a tool called the Plan Finder on Medicare.gov. You can enter your zip code, your current medications (including Trulicity), and your pharmacy, and the tool will show you all available Part D plans and what each one charges for your drugs. This is especially useful during the annual enrollment period if you are thinking about switching plans.

Frequently Asked Questions

Does Original Medicare cover Trulicity without Part D?

No. Original Medicare (Part A and B) does not cover any prescription drugs. You must have Part D coverage — either a standalone Part D plan or a Medicare Advantage plan with drug benefits — to have Trulicity covered by Medicare.

What if I cannot afford my copay for Trulicity?

Eli Lilly offers a copay information program for Trulicity. You may pay as little as $0 to $15 per month depending on your income and insurance. Ask your pharmacy or doctor for an process, or visit the manufacturer's website. Some community health centers also offer sliding-scale pricing if you are uninsured or underinsured.

Can I use GoodRx or a discount card instead of my Medicare plan?

You should not use a discount card or coupon if you have Medicare Part D. Using them voids your Part D coverage for that prescription and may affect your out-of-pocket costs later in the year. Always use your Medicare card at the pharmacy.

What if my plan covers Trulicity but the pharmacy says it is not in stock?

Ask the pharmacy to order it or to tell you which nearby pharmacies have it in stock. You can also ask your doctor to write the prescription for a 30-day supply instead of 90 days if supply is tight. If a specific pharmacy consistently cannot stock it, consider switching pharmacies.

Does Medicare cover the Trulicity pen or only the medication inside it?

Medicare Part D covers the medication and the delivery device (the pen) as one unit. You do not pay separately for the pen. Your copay or coinsurance covers the whole prescription.