Type 2 diabetes is a lifelong condition that doesn’t let your body use insulin properly – leading to high blood sugar levels. You may also develop severe complications like:

• Kidney damage
• Heart disease
• Blindness

Thankfully, it’s very easy to manage Type 2 diabetes using Trulicity. This is a prescription drug that maintains the blood sugar level for a week. You can eat the majority of the foods without feeling nauseous. 

But what is Medicare’s stance on this life-saving medicine? Is Trulicity insulin covered by Medicare or will you have to find other ways to pay for it?

Does Medicare Part D cover Trulicity?

Medicare Part D is an optional plan that can be added to Original Medicare (Part A and Part B). It is also included in most Medicare Advantage (Part C) plans. It helps cover the cost of prescription drugs.

Since Trulicity is a prescription medication, it falls under the coverage of Part D plans. However, the specifics of coverage, such as copayments, deductibles, and tier placement (which affects the cost you pay), can vary among different plans.

To determine Trulicity’s coverage under your specific Medicare Part D plan, it’s essential to review the plan’s formulary or contact the plan provider directly. This will give you details on whether Trulicity is covered, at what cost, and if there are any requirements such as prior authorization.

Is there a generic alternative to Trulicity?

Trulicity is a brand-name medication that contains dulaglutide and is used to treat type 2 diabetes. Generics typically become available after the expiration of patents and exclusivity rights held by the brand-name manufacturer.

As of 2023, there is no generic alternative to Trulicity available. Their patent extends until 2024 (no news of potential patent extensions has been heard of yet), and it’s also safeguarded by biologics data package protection until 2026.

Trulicity cost with Medicare

Trulicity is an expensive medicine that costs $930.88 per month. This price is only going to increase as time passes. So, having insurance is a must. 

Here’s what you should expect to pay for Trulicity with Medicare:

Medicare Part D 

Under Medicare Part D, the cost of Trulicity is typically $0 to $100 per month. The exact amount will depend on whether you have paid your annual deductible and what your plan copayment is. 

As of 2024, the yearly deductible of the Part D plan can’t be more than $545. If you’ve spent this amount on the purchase of prescription drugs, the insurance plan will kick in and cover some of the cost. 

Review your plan to know the agreed copayment amount. Typically, Trulicity is a tier 3 drug with higher copayments. 

Note: Low-income beneficiaries may qualify for Medicaid or the Extra Help Program. This can bring down your Trulicity cost to $4 a month. 

Medicare Part C

Part C plans usually have lower deductibles and premiums than Part D plans. The average Part C premium is $18.50 per month in 2024. So, you won’t have to spend much before insurance starts covering your expenses. 

However, note that prescription drug coverage is regulated using a formulary (list of covered drugs). The co-payment for Trulicity will greatly depend on whether your plan has placed the drug in a higher or lower tier.

Good to Know: Drugs on lower tiers have lower copayments and vice versa. 

Help with Trulicity costs

If your Medicare plan doesn’t offer Trulicity coverage or the covered amount isn’t enough, don’t worry. Here are some other ways to pay for this life-saving medicine:

Trulicity Savings Card

The Trulicity Savings Card is one of the best ways to get Trulicity at reduced prices. Offered by the manufacturer, this card allows you to buy 12 pens of Trulicity for just $25. It stays active for 12 months after which you must reapply. 

However, it is only open to commercial insurance beneficiaries. You won’t qualify if you have any government-funded insurance like Medicare.

Trulicity Assistance Programs for Medicare

Eli Lilly and Company (manufacturer of Trulicity) has a patient assistance program that offers free medication to the beneficiaries. You can apply here to get Trulicity at no cost. 

Please note that you must be a low-income US resident to qualify. You should also have no Medicaid, Extra Help, VA Benefits, or any type of private insurance. 

Trulicity coupons

Popular pharmacies, like Walmart and Walgreens, sell Trulicity at a retail price of $1000+. But they also offer discount coupons now and then. Using these coupons, you can get a 30-day supply of Trulicity for $800 or less. 

State Pharmaceutical Assistance Programs (SPAPs)

Some states offer additional assistance for prescription drug costs through SPAPs. These programs may provide help for medications not fully covered by Medicare. Visit medicare.gov to check if your state offers any assistance programs. 

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Takeaway

Trulicity and Medicare may sound like a complex topic, but it’s not. This injectable medicine is important to regulate the blood sugar levels of Type 2 diabetes patients, and it can’t be purchased without a written prescription. 

So, Medicare will cover it 99% of the time. There is a 1% chance that Part C may not include it in the plan. 

To confirm this, talk to your plan provider and review the documents. And if you haven’t enrolled in a Medicare plan yet, contact HellaHealth to find the best plan for your healthcare needs!