Medicare covers various costs relating to diabetes treatment. Medicare Part C, which is known as Medicare Advantage, and Part D might cover people with type 2 diabetes.
Some doctors may prescribe drugs, including Trulicity, to help manage a person’s diabetes, but only certain parts of Medicare cover Trulicity costs. Trulicity is the brand-name medication for dulaglutide, which helps treat diabetes.
This article explains which parts of Medicare may cover Trulicity. It also provides information about the drug, costs, and financial help.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Only certain parts of Medicare may cover Trulicity. Original Medicare Part A and Part B do not provide the necessary coverage.
Medicare Part C (Medicare Advantage)
Medicare Part C, also known as Medicare Advantage, may cover Trulicity costs. Private insurance companies administer Medicare Advantage plans, which combine all the benefits of Part A and Part B and often include extra coverage.
Most Medicare Advantage plans also cover prescription drugs. According to the Kaiser Family Foundation (KFF), in 2021, 89% of Medicare Advantage plans included coverage for prescription medicines.
As Medicare Advantage plans differ according to the plan provider, a person can review the medications that each plan covers before selecting a specific policy.
Part D prescription drug plans
Original Medicare does not cover take-home prescription drugs except in limited circumstances. However, a person can choose a stand-alone Medicare Part D prescription drug plan to meet their medication needs.
As with Medicare Advantage, private insurance companies administer Part D plans. Some Part D plans cover Trulicity, but they are not all the same, with coverage often differing among plan providers.
Every policy must cover two options for each of the most common prescription drugs. Plans usually cover a brand-name drug and the generic version from the same medication category.
Formularies
Each plan that includes coverage for prescription drugs has a list of the covered medications, known as a formulary. To determine whether a specific plan covers a drug, a person can check their formulary or contact their insurer for information.
Plan providers may change drug lists throughout the year by adding or removing a drug. Private insurers must provide individuals with a 60-day notice of their drug coverage changes.
The list price for Trulicity is $977.42 per month. For those eligible for Medicare, the costs of Trulicity vary among plans, and copayments and deductibles may also differ.
A person can contact Medicare to discuss what coverage they offer for their specific plan.
Programs are available to help with the costs of prescription medication.
Medicare offers the Extra Help program, which assists people with limited resources and income in paying for their drug costs. These expenses include any applicable coinsurance, deductibles, and premiums.
Extra Help may provide assistance worth approximately $5,900 a year.
Other assistance programs are also available. The requirements to qualify for help vary, but most programs are for those with limited income.
Additional state, federal, and private programs for cost assistance include:
- Medicaid
- State Pharmaceutical Assistance Programs
- National Patient Advocate Foundation
Trulicity is a prescription medication that some people with type 2 diabetes use to manage the condition.
The medication is a glucagon-like peptide-1 receptor agonist that works by controlling blood sugar levels. The drug’s active ingredient is called dulaglutide.
Trulicity and diabetes
Maintaining control of blood sugar levels is key to managing diabetes. Dulaglutide promotes the proper release of insulin from the pancreas. It also helps slow digestion to prevent blood sugar spikes and limits glucose release from the liver into the blood.
This combination of effects helps control blood sugar levels, preventing them from becoming too high and thereby reducing the risk of health complications.
Uncontrolled blood sugar levels can lead to significant complications, such as heart disease, kidney disease, and eye damage.
How do people administer Trulicity?
Trulicity is a once-weekly injection that comes in a premeasured syringe. A person administers the drug themselves, injecting it into their abdomen, thigh, or upper arm.
The drug is available by prescription only, and different dosing options are available. A doctor will prescribe the appropriate dose.
There is currently no generic version of Trulicity, but this might become available once the patent expires.
Other glucagon-like peptide-1 receptor agonist medications are available,
- liraglutide (Victoza)
- semaglutide (Ozempic)
- exenatide (Bydureon)
Other medications that are not glucagon-like peptide-1 receptor agonists are available to help control blood sugar levels.
Every person is different, and it is essential to work with a medical professional to determine the best diabetes medications for optimal management.
Below are answers to common questions about diabetes medications with Medicare coverage.
What diabetes medications fall under Medicare coverage?
Medicare Part D covers insulin and antidiabetic drugs. The specific diabetes medication can depend on a person’s plan. They may include alpha-glucosidase inhibitors, biguanides, glucagon-like peptide 1 (GLP-1) receptor agonists, meglitinides, sodium-glucose co-transporter 2 (SGLT2) inhibitors, sulfonylureas, and thiazolidinediones.
What tier does Trulicity fall under?
Trulicity is a tier 3 drug, which typically has a higher copayment than medications in tiers 1 and 2.
Trulicity is a once-weekly injectable medication that people with type 2 diabetes may use to help maintain control of their blood sugar levels.
Some Medicare Part D plans cover Trulicity. Specific Medicare Advantage plans that offer drug coverage may also cover this medication.
Prescription drug plans provide individuals with a formulary — a list of medications that the plan covers — so they can check whether it includes their required medication.
The exact cost of Trulicity varies depending on the provider of the prescription drug plan.
Those eligible for Medicare can contact their plan provider for specific information on coverage and costs. They can also find out whether they qualify for extra assistance.