What Trulicity is used for
Trulicity is a once-weekly GLP-1 injection. Its FDA label covers improving blood sugar in adults and children 10 and older with type 2 diabetes, and reducing the risk of major cardiovascular events in adults with type 2 diabetes who have heart disease or several heart risk factors. It isn't approved for weight loss.
This page explains Medicare coverage only. Questions about whether Trulicity is right for you belong with your prescriber.
Which part of Medicare covers Trulicity
Trulicity is a single-dose pen you use at home, so it's a Part D drug. As with other GLP-1 drugs, plans may require prior authorization to confirm it's for diabetes, because Part D can't cover drugs used for weight loss alone.
Is Trulicity on Medicare's negotiated-price list?
CMS selected Trulicity on January 27, 2026, for the third round of the Medicare Drug Price Negotiation Program. Negotiations take place in 2026, and CMS says prices from this round take effect in 2028. Trulicity was the highest-spending drug on the third-round list: CMS counted about 617,000 people with Medicare who used it from November 2024 through October 2025.
What the 2028 timeline means for you
For 2027, Trulicity's coverage and cost depend only on your plan's formulary and the Part D rules on this page. CMS and the manufacturer negotiate during 2026, and the resulting price would apply from 2028. When you compare plans each fall, keep checking Trulicity on each plan's formulary; a negotiated price doesn't guarantee a plan covers it or sets a particular copay.
What you pay for Trulicity in 2027: the out-of-pocket cap
Your cost for Trulicity depends on your plan: its deductible, the tier it puts the drug on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:
- 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
- The maximum Part D deductible for 2027 is $700. No plan can set a higher deductible.
- Only covered drugs count. If your plan doesn't cover Trulicity and you pay cash, or you use a discount card instead of your plan, that spending doesn't count toward the cap.
Spreading the cost: the Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan lets you pay your Part D drug costs in monthly bills from your plan across the calendar year instead of all at once at the pharmacy. Medicare.gov says there's no cost to participate, but it doesn't lower your drug costs; it only changes when you pay. It helps most when costs are high early in the year. To join, call your plan or use its website. More in What is the Medicare Prescription Payment Plan?
Extra Help with Trulicity
Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have OHP (Medicaid), a Medicare Savings Program or SSI; otherwise apply through Social Security at 1-800-772-1213 or ssa.gov/extrahelp. See Extra Help in Oregon.
Getting Trulicity covered in Oregon
Where you live in Oregon changes your choices. CMS data show no Medicare Advantage plan open to everyone in Grant, Harney, Lake, Umatilla or Union counties for 2027 (only employer group plans), and only a special needs plan in Curry County. If you live there, coverage for Trulicity usually comes from a standalone Part D plan alongside Original Medicare, unless you have employer or other drug coverage. Check your county's numbers on Oregon counties.
If you have both Medicare and OHP, OHP doesn't pay for drugs that Part D covers. The Oregon Health Authority calls this "OHP with Limited Drug": you need a Part D plan (or a Medicare Advantage plan with drug coverage) for Trulicity, and you qualify for Extra Help automatically. See OHP and Medicare.
Oregon and Washington share Part D region 30, so standalone Part D plans are offered region-wide. For 2027, Oregon has 8 standalone Part D plans from 4 companies, plus Medicare Advantage plans with drug coverage in most counties (61 open to everyone statewide). Each plan has its own formulary, so one plan's coverage of Trulicity tells you nothing about another's.
How to check whether a plan covers Trulicity
- Write down the exact drug. Name, strength and how often you take it. A plan can cover one form of Trulicity and not another.
- Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Trulicity and any rules.
- Read the rules next to the drug. Prior authorization, step therapy or quantity limits mean your prescriber may need to send the plan information before it pays.
- Check your 2027 notice. Your plan's Annual Notice of Change says whether Trulicity stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
- Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.
If your plan doesn't cover Trulicity, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if your prescriber says waiting could seriously harm your health. New members can usually get a one-time transition supply of a drug they were already taking while they ask for an exception or switch. See How do I appeal a Medicare denial in Oregon?
Sources
- National Library of Medicine — DailyMed: Trulicity prescribing information (FDA label)
- Medicare.gov — Drug coverage (Part D)
- CMS — Selected drugs for initial price applicability year 2028 (fact sheet, January 2026)
- CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program)
- CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold and Extra Help copays)
- Medicare.gov — Medicare Prescription Payment Plan
- Social Security — Extra Help with Medicare prescription drug plan costs
- CMS — Part D plan files record layout (PDP Region 30: Oregon, Washington)
- Oregon Health Authority — OHP and Medicare
Frequently asked questions
When will Trulicity have a Medicare negotiated price?
CMS selected Trulicity on January 27, 2026, for the third round of negotiation. CMS says prices from that round take effect in 2028.
Does Medicare cover Trulicity for weight loss?
No. Trulicity isn't FDA-approved for weight loss, and Part D can't cover drugs used for weight loss alone. It's covered for type 2 diabetes.
Does the 2027 Part D out-of-pocket cap apply to Trulicity?
Yes, when your Part D plan covers Trulicity. In 2027, once you've paid $2,400 for covered Part D drugs, you pay nothing more for covered Part D drugs for the rest of the year.
What if my plan doesn't cover Trulicity?
Ask the plan for a coverage determination or formulary exception, with a supporting statement from your prescriber, or compare plans during Open Enrollment, October 15 to December 7. New members can usually get a transition fill while they ask.
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