What Insurance Pays for Trulicity: Your Guide to Coverage
Trulicity is a popular medication for managing type 2 diabetes. Many people want to know what insurance pays for Trulicity. This article explains coverage in simple terms. It helps you understand costs and options.
What Is Trulicity?
Trulicity is a once-weekly injectable drug. It contains dulaglutide, which helps control blood sugar. Doctors prescribe it for adults with type 2 diabetes. It’s often used with diet and exercise.
The drug comes in pre-filled pens. Common doses are 0.75 mg and 1.5 mg. Higher doses like 3 mg or 4.5 mg are available. It’s brand-name only, with no generic version.
Why Insurance Coverage Matters
Trulicity is expensive without insurance. A 30-day supply costs around $1,000. Insurance can lower this to $25–$200. Knowing what insurance pays for Trulicity saves money.
Coverage varies by plan. Some plans cover Trulicity fully, others require copays. Understanding your plan’s rules avoids surprises.
How Insurance Covers Trulicity
Most commercial insurance plans cover Trulicity. It’s a common treatment for type 2 diabetes. Coverage often requires proof of medical necessity. A diagnosis of type 2 diabetes is usually enough.
Copays range from $25 to $200. Trulicity is often in higher formulary tiers. This means higher out-of-pocket costs.
Prior Authorization Requirements
Many plans require prior authorization. Your doctor must submit paperwork. This shows why Trulicity is necessary. Without approval, you may pay the full cost.
The process involves medical records. Failed attempts with other drugs may be noted. Approval takes days to weeks.
Step Therapy and Restrictions
Some plans use step therapy. You may need to try metformin first. If it fails, Trulicity may be covered. This ensures cost-effective treatment.
Plans may limit supply. A 30-day prescription is standard. Some allow 90-day supplies for convenience.
Medicare and Medicaid Coverage
Medicare Part D covers Trulicity. It’s on most Part D formularies. Copays range from $40–$200. The Medicare coverage gap may increase costs.
Medicaid covers Trulicity in most states. Copays are $0–$10. Prior authorization may be required. Check with your state’s Medicaid office.
Commercial Insurance Plans
Plans like Blue Cross Blue Shield or Aetna cover Trulicity. Coverage requires a type 2 diabetes diagnosis. Prior authorization is common. Check your plan’s formulary for details.
With insurance, copays can be $25–$200. The Trulicity Savings Card lowers costs. It’s offered by Eli Lilly, the manufacturer.
Table: Typical Copays for Trulicity with Commercial Insurance
| Insurance Provider | Copay Range | Prior Authorization Needed? |
|---|---|---|
| Blue Cross Blue Shield | $25–$150 | Yes |
| Aetna | $30–$200 | Yes |
| Cigna | $40–$180 | Sometimes |
Note: Copays vary by plan. Contact your insurer for exact costs.
Savings Programs and Discounts
Eli Lilly offers the Trulicity Savings Card. Insured patients may pay as little as $25. The card covers up to $150 per prescription. It’s valid for 12 months.
GoodRx coupons can reduce costs. A 30-day supply may cost $800 with a coupon. Prices vary by pharmacy.
Lilly Insulin Value Program
The Lilly Insulin Value Program includes Trulicity. Cash-paying patients may pay $35 per month. This is ideal for uninsured patients. Enrollment is required.
Mail-order pharmacies offer savings. A 90-day supply may cost less. Shipping fees may apply.
Factors Affecting Coverage
Your diagnosis impacts coverage. Trulicity is covered for type 2 diabetes. Off-label uses may require extra documentation. Your plan’s formulary is also key.
Formularies list covered drugs. Trulicity is often non-preferred. This leads to higher copays. Check your formulary early.
Medical Necessity and Documentation
Insurers need proof of type 2 diabetes. Blood sugar records may be required. Prior authorization ensures medical necessity. Your doctor handles this.
Without clear evidence, coverage may be denied. Regular check-ins strengthen your case. Keep medical records updated.
Pharmacy Restrictions
Trulicity is available at most pharmacies. In-network pharmacies offer better rates. Some plans require mail-order for 90-day supplies. Confirm your pharmacy’s status.
Specialty pharmacies may handle Trulicity. They ensure proper storage and delivery. Your insurer may specify a pharmacy.
Alternatives to Insurance Coverage
If Trulicity isn’t covered, other drugs exist. Ozempic and Victoza are similar injectables. They may have different coverage rules. Metformin is a cheaper oral option.
Lifestyle changes help manage diabetes. Diet and exercise can lower blood sugar. A diabetes educator can provide guidance.
Patient Assistance Programs
Eli Lilly offers patient assistance. Uninsured patients may get Trulicity free. Eligibility depends on income. Call 1-833-808-1234 for details.
Nonprofits like RxAssist help with costs. They connect patients to resources. Verify eligibility before applying.
Tips for Getting Coverage
Talk to your doctor first. They can submit prior authorization paperwork. Provide your diabetes history and blood sugar records. This supports your case.
Contact your insurer early. Ask about copays and formulary status. Confirm prior authorization rules. This prevents delays.
Working with Your Pharmacist
Pharmacists can suggest savings. They may recommend the Trulicity Savings Card. They can confirm in-network status. Building a relationship helps.
Ask about 90-day supplies. These reduce costs and visits. Your insurer may need to approve this.
What to Do If Coverage Is Denied
Denials often stem from missing paperwork. Your doctor can resubmit with details. Include medical records and prior drug failures. Appeals can reverse denials.
Submit appeals within your plan’s deadline. Your doctor’s letter should explain Trulicity’s necessity. Follow up to track progress.
Exploring Other Medications
If Trulicity isn’t covered, try Ozempic or Bydureon. They work similarly. Oral drugs like Januvia are options. Discuss alternatives with your doctor.
Insulin is another route. It’s covered by most plans. Costs vary by type and dose.
Summary
Understanding what insurance pays for Trulicity helps manage costs. Most commercial plans and Medicare cover it with prior authorization. Medicaid coverage varies by state.
Savings programs like the Trulicity Savings Card and Lilly’s assistance lower expenses. Work with your doctor and insurer to confirm coverage. With preparation, Trulicity is accessible.
FAQ
Does Medicare cover Trulicity?
Medicare Part D covers Trulicity. Copays range from $40–$200. The coverage gap may increase costs.
How much is Trulicity without insurance?
Trulicity costs about $1,000 for a 30-day supply. GoodRx lowers it to $800. The Lilly program offers it for $35.
What is prior authorization for Trulicity?
Prior authorization requires proof of medical necessity. Your doctor submits records. It may delay coverage.
Can I use the Trulicity Savings Card with insurance?
Yes, insured patients pay as little as $25. The card covers up to $150. Check eligibility at trulicity.com.
What if my insurance denies Trulicity?
Appeal with your doctor’s help. Provide medical records and drug history. Consider Ozempic or metformin as alternatives.