Does Medicaid Cover Trulicity? Criteria, Copay, How to Appeal
Yes for type 2 diabetes: every state Medicaid program covers GLP-1 diabetes drugs like Trulicity, usually with prior authorization. Only 10 states also cover GLP-1s for weight loss.
- States covering weight loss
- 10
- Covered for type 2 diabetes
- Every state
- States covering in January 2026
- 13
- Prior authorization
- Typical
Trulicity overview
Its half-life is about 5 days. After 5 d, half is gone, while about 3% remains after five half-lives (25 d).
Sources: FDA label (DailyMed).
Does Medicaid cover Trulicity?
| Medicine | Approved for | Medicaid covers it in |
|---|---|---|
| Trulicity | Type 2 diabetes and heart risk | Every state |
Sources: pricinginfo.lilly.com, trulicity.lilly.com, lillycares.com, GoodRx.
Published policy
- Yes: diabetes GLP-1s must be covered by states
- In October 2025, 16 states covered weight loss
- Weight loss was covered in 13 states in January 2026
- Prior authorization must be obtained
- Changes in 2026:
- Michigan: Rules have been tighter since January 2026 (effective January 1, 2026), and coverage is included
- In Pennsylvania, coverage ended January 2026 (effective January 1, 2026)
- The Utah pilot closed in June 2026 (effective June 30, 2026)
- Coverage in Wisconsin requires prior authorization (effective July 1, 2026)
- Massachusetts ended coverage in July 2026 (effective July 3, 2026)
- Rhode Island: Coverage ended in October 2026 (took effect October 1, 2026)
Read the policy at KFF.
Sources: KFF, michigan.gov, pa.gov, medicaid-documents.dhhs.utah.gov.
Prior authorization checklist
- Diagnosis: Either type 2 diabetes appears in your chart, or your chart lists Trulicity as approved for heart risk.
- Prior authorization must be obtained
- Records: Provide recent A1C results and list the diabetes drugs you have already tried.
- Who files it: The prior authorization comes from your prescriber, not you
Source: KFF.
How to appeal if you are denied
| Denial reason | What to send or ask |
|---|---|
| Prior authorization missing | Your prescriber sends the plan's form with your type 2 diabetes diagnosis and recent A1C results. |
| The plan wants another drug first | Ask which drugs the plan wants tried first, and send records of those you have already tried. |
| The drug is not on the plan's list | Ask for a formulary exception, and find out which GLP-1 the plan prefers as an alternative |
- Get your Medicaid plan's denial notice because it names the rule that was not met.
- Chart notes may accompany your prescriber's resubmission of the prior authorization.
- If the plan still denies coverage, you can ask for a state fair hearing.
State and plan differences
| State | For weight loss | For type 2 diabetes | Prior authorization |
|---|---|---|---|
| Alabama | Not covered | Covered | Not listed |
| Alaska | Not covered | Covered | Not listed |
| Arizona | Not covered | Covered | Not listed |
| Arkansas | Not covered | Covered | Not listed |
| California | Ended January 2026 | Covered | Not listed |
| Colorado | Not covered | Covered | Not listed |
| Connecticut | Not covered | Covered | Not listed |
| Delaware | Covered with prior authorization | Covered | Required |
| District of Columbia | Not covered | Covered | Not listed |
| Florida | Not covered | Covered | Not listed |
| Georgia | Not covered | Covered | Not listed |
| Hawaii | Not covered | Covered | Not listed |
| Idaho | Not covered | Covered | Not listed |
| Illinois | Not covered | Covered | Not listed |
| Indiana | Joining BALANCE, start date not set | Covered | Not listed |
| Iowa | Not covered | Covered | Not listed |
| Kansas | Covered with prior authorization | Covered | Required |
| Kentucky | Not covered | Covered | Not listed |
| Louisiana | Not covered, law allows coverage from 2027 | Covered | Not listed |
| Maine | Not covered | Covered | Not listed |
| Maryland | Not covered | Covered | Not listed |
| Massachusetts | Ended July 2026 | Covered | Required |
| Michigan | Covered, tighter rules since January 2026 | Covered | Required |
| Minnesota | Covered with prior authorization | Covered | Required |
| Mississippi | Covered | Covered | Not listed |
| Missouri | Covered with prior authorization | Covered | Required |
| Montana | Not covered | Covered | Not listed |
| Nebraska | Not covered | Covered | Not listed |
| Nevada | Not covered | Covered | Not listed |
| New Hampshire | Ended January 2026 | Covered | Not listed |
| New Jersey | Not covered | Covered | Not listed |
| New Mexico | Not covered | Covered | Not listed |
| New York | Not covered | Covered | Not listed |
| North Carolina | Covered with prior authorization | Covered | Required |
| North Dakota | Not covered | Covered | Not listed |
| Ohio | Not covered | Covered | Not listed |
| Oklahoma | Not covered | Covered | Not listed |
| Oregon | Not covered | Covered | Not listed |
| Pennsylvania | Ended January 2026 | Covered | Not listed |
| Rhode Island | Ended October 2026 | Covered | Required |
| South Carolina | Ended January 2026 | Covered | Not listed |
| South Dakota | Not covered | Covered | Not listed |
| Tennessee | Covered with prior authorization | Covered | Required |
| Texas | Not covered | Covered | Not listed |
| Utah | Pilot ended June 2026 | Covered | Required |
| Vermont | Not covered | Covered | Not listed |
| Virginia | Covered with strict service authorization | Covered | Required |
| Washington | Not covered | Covered | Not listed |
| West Virginia | Not covered | Covered | Not listed |
| Wisconsin | Covered with prior authorization | Covered | Required |
| Wyoming | Not covered | Covered | Not listed |
Sources: KFF, medicaidpublications.dhss.delaware.gov, events.in.gov, kdhe.ks.gov.
Other ways forward if coverage says no
| Route | Who it is for | What you pay | Limits and dates |
|---|---|---|---|
| Lilly Cares | Household income no higher than 300% of the federal poverty level | Free for up to 12 months | Income limit 300% of the poverty level |
Prices checked November 2026. Every price takes you to the page where it comes from.
Sources: pricinginfo.lilly.com, trulicity.lilly.com, lillycares.com, GoodRx.