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does Medicare cover Trulicity

Does Medicare Cover Trulicity?

People commonly use Trulicity to manage their Type 2 diabetes. The manufacturer says it stimulates the body’s natural production of insulin while slowing down digestion and the release of glucagon. While Trulicity may be helpful, it can also be expensive.

So a common question many people have is, “does Medicare cover Trulicity?” In this article, we answer that question in clear, plain English. You will also find the average costs of Trulicity and other helpful info.

Does Medicare Cover Trulicity?

The short answer is no. In most cases, Medicare will not cover the cost of Trulicity. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your Trulicity. 

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for Trulicity. That is because Original Medicare mainly covers medically necessary services, equipment, and treatment rather than prescription drugs. Prescription drug coverage may be provided by either Medicare Advantage plans or by Medicare Part D. 

Part C and Part D Coverage for Trulicity

However, some Medicare Advantage plans (Medicare Part C) provide coverage for Trulicity. Medicare Advantage plans cover everything Original Medicare covers and some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.

Medicare Part D plans also provide coverage for Trulicity. About 84 percent of both Medicare Part C and Part D plans provide coverage for the medication Trulicity. 

Most Medicare plans restrict the amount of purchase for Trulicity per one time. If you need to purchase a greater amount of Trulicity at one time, Medicare may not cover it. You can either wait until the period has passed before refilling or contact your plan provider and ask for an exception.

Trulicity is listed as a Tier 3 drug in the Medicare drug formulary. Most of the time Tier 3 medications are preferred branded medications. Tier 3 medications are more expensive than Tier 1 and 2 medications. 

How Much Does Trulicity Cost?

A carton of 0.75 mg of Trulicity, which contains 4 pens, typically costs between $900 and $1,000. This price varies from pharmacy to pharmacy. 

What is Trulicity?

Adults who suffer from Type 2 diabetes commonly use Trulicity to help glycemic control. It is a type of medication known as glucagon-like peptide-1 receptor agonist, or GLP-1RA. Medications listed as GLP-1RA include the following: 

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

Even though the medications stated above are GLP-1RA much like Trulicity, as of now there are no generic alternatives to this medication.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover Hospice?

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