Trulicity coverage guide: formulary tiers, prior authorization, and patient assistance

Trulicity (dulaglutide, Eli Lilly) is a once-weekly subcutaneous GLP-1 receptor agonist approved by the FDA for improving glycemic control in adults with type 2 diabetes and for reducing the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors. It was first approved in September 2014 and received the cardiovascular risk reduction indication in February 2020 based on the REWIND trial, which demonstrated a 12% reduction in MACE.

This coverage guide is for prescribers, access teams, pharmacists, and patients who need to navigate payer requirements, prior authorization, and affordability programs for Trulicity.

FDA-approved indications and dosing

Notable: Trulicity is the first GLP-1 receptor agonist to show cardiovascular benefit in a population primarily without established cardiovascular disease (REWIND trial). This differentiates its label from Ozempic, which demonstrated CV benefit in patients with established CVD (SUSTAIN-6).

Trulicity is not approved for weight management or type 1 diabetes.

Formulary placement and prior authorization

Trulicity is widely covered across commercial, Medicare, and Medicaid formularies for its FDA-approved type 2 diabetes indication. It is not covered for weight loss.

Commercial insurance

Across major commercial formularies, Trulicity is typically placed at:

Common prior authorization criteria across commercial payers include:

• Documented diagnosis of type 2 diabetes (ICD-10 code E11.x on claim or chart notes)
• Recent A1c showing inadequate control (typically ≥ 6.5% or above target)
• Trial and failure or intolerance of metformin (unless contraindicated)
• Some plans require step therapy through metformin before approving any GLP-1
• Quantity limit of 4 pens per 28 days (one month supply)

Medicare Part D

Medicare Part D covers Trulicity for its FDA-approved type 2 diabetes and cardiovascular indications. It is not covered for weight loss.

Key Medicare access points:

• Most Part D plans place Trulicity at Tier 3 (preferred brand or non-preferred brand depending on plan), requiring prior authorization for new starts
• PA typically requires documented T2DM diagnosis, recent A1c results, and proof of prior therapy (e.g., metformin)
• Approximately 70% of Medicare beneficiaries pay $100 or less per month for Trulicity with Part D coverage
• Under the IRA Medicare Part D redesign, the out-of-pocket cap is $2,100 in 2026
• CMS is launching a GLP-1 payment demonstration beginning July 2026 for Medicare beneficiaries, with eligible beneficiaries paying $50/month for GLP-1 medications — though this initially targets obesity indications and may not directly change Trulicity access for T2DM

Medicaid

Medicaid coverage for Trulicity varies by state:

• Most state Medicaid programs cover Trulicity as a preferred or non-preferred brand with prior authorization
• PA criteria typically require documented T2DM diagnosis, A1c results, and trial of metformin
• Michigan Medicaid: Trulicity is a preferred brand with PA (ICD-10 or T2DM medication history required)
• Some states classify Trulicity as non-preferred, requiring step therapy through preferred GLP-1s first
• Trulicity is not covered by Medicaid for weight loss in most states; as of January 2026, 13 state Medicaid programs cover GLP-1s for obesity treatment under fee-for-service

Supply constraints

Trulicity has been on the FDA drug shortage list since December 2022. Key points:

• Eli Lilly has shifted manufacturing priority toward Mounjaro (tirzepatide) and Zepbound (tirzepatide), reducing Trulicity production capacity
• The 3 mg and 4.5 mg strengths have had limited availability; the 0.75 mg and 1.5 mg strengths have been more consistently available
• As of early 2026, the manufacturer reports all presentations are available, but the FDA still lists dulaglutide injection as "in shortage" with availability under review
• Prescribers should check the FDA Drug Shortage Database for current status before initiating new patients on higher doses
• The shortage has implications for prior authorization: some payers may approve dose escalation to 3 mg or 4.5 mg but patients may face delays filling the prescription

Copay and patient assistance

Trulicity Savings Card (commercial insurance only)

Eli Lilly offers a manufacturer savings card for commercially insured patients:

Over 90% of commercially insured patients pay between $0 and $30 monthly when using the savings card.

LillyDirect

Eli Lilly's LillyDirect platform offers home delivery and competitive pricing for Trulicity. Patients can access Trulicity through LillyDirect with a valid prescription and may benefit from bundled savings programs.

Lilly Cares Foundation Patient Assistance Program

The Lilly Cares Foundation provides free Trulicity to eligible uninsured or underinsured patients:

• Income requirement: household income at or below 300% of the Federal Poverty Level
• Application at lillycares.com or 1-800-545-6962
• Important: As of early 2026, new applications for Trulicity are temporarily not being accepted except for limited medical exception cases. Re-enrollment for current participants is still being accepted.

Discount cards (cash pay)

For patients without insurance coverage:

• SingleCare: approximately $825 per fill at participating pharmacies
• GoodRx: approximately $952 per fill at participating pharmacies
• Retail cash price: approximately $1,395 per fill (4 pens)

Specialty pharmacy routing

Trulicity is a self-administered subcutaneous injection and does not typically require specialty pharmacy distribution. It can be filled at most retail and mail-order pharmacies. However, some plans may designate it as a specialty medication and require fulfillment through a preferred specialty pharmacy (e.g., Optum Specialty, CVS Specialty, Accredo).

Prior authorization checklist

When submitting prior authorization for Trulicity, prepare:

1. Diagnosis documentation: ICD-10 code E11.x (type 2 diabetes mellitus) documented in chart notes
2. A1c results: Recent HbA1c showing inadequate control (typically ≥ 6.5% or above treatment target)
3. Prior therapy: Documentation of metformin trial (at least 30 days), or contraindication/intolerance to metformin
4. Indication: Clearly state "type 2 diabetes mellitus" and/or "cardiovascular risk reduction per REWIND trial" as the clinical rationale
5. Prescriber specialty: Endocrinology or primary care; some plans may require specialist consultation
6. Dosing: Specify starting dose (0.75 mg or 1.5 mg) and titration plan

What to monitor next

• FDA shortage status: The dulaglutide shortage has persisted since 2022. Watch the FDA Drug Shortage Database for resolution or worsening of availability
• GLP-1 pipeline: Eli Lilly's SURPASS-CVOT trial showed tirzepatide (Mounjaro) was non-inferior to Trulicity for cardiovascular outcomes, and Lilly is shifting commercial focus toward tirzepatide. Trulicity's market position may continue to decline
• IRA GLP-1 demonstration: CMS plans to launch the GLP-1 payment model in July 2026, which may indirectly affect Trulicity coverage and pricing dynamics
• New GLP-1 entrants: Orforglipron (oral, Eli Lilly) and cagrilintide + semaglutide (Novo Nordisk) are in late-stage development and could shift formulary positioning for existing GLP-1s
• Prior authorization reform: CMS proposed new interoperability standards in 2026 that would require payers to share detailed PA decision data through APIs, potentially streamlining the PA process for drugs like Trulicity starting October 2027

Disclaimer

This article is for informational purposes only and does not constitute medical advice. Coverage, formulary placement, and prior authorization criteria vary by plan and change frequently. Always verify current requirements with the patient's specific payer.

Sources

• FDA. Trulicity (dulaglutide) prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/125469s051lbl.pdf
• Gerstein HC, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). Lancet. 2019;394(10193):121-130. https://pubmed.ncbi.nlm.nih.gov/31189511/
• CMS. Medicare GLP-1 payment demonstration and BALANCE model. https://www.cms.gov/newsroom/press-releases/cms-launches-voluntary-model-expand-access-life-changing-medicines-promote-healthier-living
• KFF. Medicaid coverage of and spending on GLP-1s. https://www.kff.org/medicaid/medicaid-coverage-of-and-spending-on-glp-1s
• FDA Drug Shortages database. https://www.fda.gov/drugs/drug-shortages
• FDA. Clarifies policies for compounders as national GLP-1 supply begins to stabilize. https://www.fda.gov/drugs/drug-alerts-and-statements/fda-clarifies-policies-compounders-national-glp-1-supply-begins-stabilize
• Eli Lilly. Trulicity Savings Card. https://trulicity.lilly.com/savings-resources
• Lilly Cares Foundation. Patient Assistance Program. https://www.lillycares.com/how-to-apply
• Optum Rx. 2026 Premium Formulary. https://contenthub-aem.optumrx.com/content/dam/contenthub/onboarding/assets/wespath/Jan-01-2026-Premium-Formulary-Booklet.pdf
• Prime Therapeutics. GLP-1 pipeline update. https://www.primetherapeutics.com/glp-1-pipeline-update-february-2026