Does Medicare Cover Trulicity?

Does Medicare cover Trulicity?

Medicare doesn’t spell out the exact medication brands that are covered under a drug plan. Instead, Medicare requires every plan to offer two medication choices in each drug category, usually a brand name drug and its generic substitute.

A drug plan can add or remove medications from its formulary throughout the year. However, the plan must provide you with 60 days’ notice of any changes in coverage for medications you take.

Coverage for Trulicity depends on your specific Medicare Part D plan. You can find out which plans in your area include this medication in the formulary by using Medicare’s plan finder tool. This tool allows you to check for specific medications that are covered in your area and compare prices at different pharmacies.

Medicare Part C coverage

Medicare Part C, or Medicare Advantage, is another option for healthcare coverage under Medicare. These optional, private plans can offer many services, like inpatient, outpatient, skilled nursing, and even prescription drug coverage, all in one package.

Coverage for specific medications under a Medicare Advantage plan would depend on the options and plans offered by the company you choose. You can specify any medications you take to find out about coverage and pricing when selecting a Medicare Advantage plan.

Medigap coverage

Medigap plans are private, supplemental insurance to help cover your out-of- pocket costs with Medicare. However, there are limitations on what you can use Medigap coverage to pay for.

Typically, Medigap plans will not cover:

  • prescription medications
  • vision, dental, and hearing services
  • supplemental services like fitness and nutrition programs

Although plans sold today cannot cover your drug costs, some Medigap plans sold before 2006 did include medication coverage. If you still have such a plan, this coverage will be honored.

How much does Trulicity cost?

The list price of Trulicity is $797.30 per month. However, insurance or Medicare coverage may lower this cost. Drug manufacturers sometimes offer additional savings programs or coupons to help with costs, too.

According to GoodRx, 84 percent of Medicare Part D plans cover Trulicity. This medication is usually listed on tier 3 of drug plan formularies. Tier 3 drugs are typically nonpreferred, brand name medications with higher copayments than medications in tiers 1 or 2.

Copays for this medication will vary based on the plan you choose, but the manufacturer suggests a range of $0 to $100 per month after you’ve met your Medicare Part D deductible.

What is Trulicity?

Trulicity is a new type of medication called a glucagon-like peptide-1 receptor agonist (GLP-1RA). In addition to Trulicity, there are many other GLP-1RAs available, including:

  • Adlyxin (lixisenatide)
  • Bydureon (exenatide extended-release)
  • Byetta (exenatide)
  • Ozempic (semaglutide)
  • Rybelsus (oral semaglutide)
  • Victoza (liraglutide)

Trulicity is not a replacement for insulin therapy, but it can be used alone or with other medications or with nonmedical interventions like diet and exercise to help manage type 2 diabetes.

How does it work?

This new class of medication is especially effective when it comes to lowering blood sugar levels in people with type 2 diabetes. Trulicity, like other injectables for type 2 diabetes, comes in a prefilled syringe that you can administer yourself. Trulicity offers various dosage options based on your needs.

Medications like Trulicity and other GLP-1RAs act as a replacement or supplement to the natural hormone glucagon-like peptide (GLP-1). This hormone helps to regulate appetite and blood sugar by:

  • slowing digestion to prevent blood sugar from spiking after you eat
  • helping your body make more insulin to better manage rising blood sugar levels
  • preventing the liver from releasing too much glycogen into the bloodstream
Is there a generic?

Since Trulicity is a new medication, a generic is not currently available. Generic versions of the Trulicity cannot be produced until 2024, when the patent expires.

Is Trulicity right for me?

Trulicity may not be the best option for everyone. Check with your doctor to find out what medication is best for your specific needs. Trulicity should not be used:

  • as the first-choice therapy for people who cannot control their diabetes with diet and exercise
  • in people with type 1 diabetes or diabetic ketoacidosis
  • in people with a history of pancreatitis or gastrointestinal disorders

What is type 2 diabetes?

Diabetes is a condition that impairs your body’s ability to regulate blood sugar levels. Diabetes can be broken down into two groups: type 1 diabetes and type 2 diabetes.

Learn more

Type 1 diabetes is an autoimmune disease where the pancreas is unable to produce insulin.

Type 2 diabetes makes up about 90 percent to 95 percent of all diabetes cases. It most often develops after age 45.

This type of diabetes develops when the body becomes too used to high levels of sugar and becomes resistant to insulin — a hormone that helps the body regulate blood sugar levels. High blood sugar can cause a wide range of health conditions, and must be carefully managed with lifestyle changes and medications.

The takeaway

Trulicity is a long-lasting brand name medication that can be quite effective at lowering high blood sugar levels caused by type 2 diabetes. It is not a substitute for insulin or diet and lifestyle changes.

There is no generic version of this medication. It is usually classified as a tier 3 medication in most drug plan formulary lists.

Many Medicare Part D plans include Trulicity on formularies, but you’ll likely still pay a share of the costs. The cost you’ll pay will depend on your specific plan.

There are a variety of private and public programs that offer extra help in covering your medication costs. You can also talk with your doctor about the best way to manage your diabetes that also makes sense for your budget.

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