Does Medicare Cover Trulicity? Criteria, Copay, How to Appeal
Yes for type 2 diabetes: Medicare Part D plans cover Trulicity, with a copay set by your plan. It is not in the $50 GLP-1 Bridge, which is for weight loss.
- Medicare GLP-1 Bridge copay
- $50 a month
- Bridge runs
- July 1, 2026 to December 31, 2027
- Trulicity in the Bridge
- No
- Part D for weight loss alone
- Not covered
Trulicity in brief
About 5 days is the half-life. After 5 d, half is gone, and about 3% stays after five half-lives (25 d).
Sources: FDA label (DailyMed).
Does Medicare cover Trulicity?
| Medicine | Approved for | Part D covers | In the $50 Bridge |
|---|---|---|---|
| Trulicity | Type 2 diabetes and heart risk | Diabetes and heart-risk uses | No |
- Weight loss on its own under Part D
- Part D can cover it if you have diabetes, or if you have cardiovascular disease
- For type 2 diabetes, sleep apnea, or fatty liver, your plan may cover it
Sources: pricinginfo.lilly.com, trulicity.lilly.com, lillycares.com, GoodRx.
The published policy
- Bridge starts: July 1, 2026
- Bridge ends: December 31, 2027
- Copay under Medicare GLP-1 Bridge: $50 per month
- Drugs on the Bridge: Foundayo, Wegovy, Zepbound KwikPen
- Vials and single-dose pens are excluded from the Bridge
- No, it does not go toward your Part D deductible
Go to medicare.gov to read the policy itself
Sources: humana.com, medicare.gov, CMS.
Checklist for prior authorization
- Diagnosis: your chart lists heart risk, or type 2 diabetes, among the approved uses of Trulicity.
- Prior authorization is required for approval
- Records needed: your recent A1C results and diabetes medicines tried earlier
- Who files it: your prescriber sends the prior authorization, not you
Source: medicare.gov.
The appeal if you are denied
| Denial reason | What to send or ask |
|---|---|
| Prior authorization missing | Your prescriber sends your diagnosis of type 2 diabetes plus recent A1C, along with the plan's form. |
| The plan wants another drug first | Ask which drugs the plan wants tried first, then send the records of those you already tried. |
| The drug is not on the plan's list | Ask for a formulary exception and learn which GLP-1 your plan prefers |
- Ask your Part D plan for a coverage determination, or for an exception if the drug is missing from its list.
- Ask for a redetermination when the plan says no. Your prescriber can also add a supporting statement.
- When a redetermination does not work, an independent reviewer who is outside the plan handles the appeal instead.
What changes by state and plan
Medicare Advantage plans that include drug coverage follow the same rules. One example: Humana lists the Bridge copay at $50 for each 30-day supply.
Copay tiers and drug lists differ among Part D plans, so the copay for diabetes use varies by plan.
If you have both Medicare and Medicaid, the Medicaid rules of your state apply as well: Does Medicaid Cover Trulicity? Criteria, Copay, How to Appeal.
Source: humana.com.
Coverage says no: other routes
| Route | Who it is for | What you pay | Limits and dates |
|---|---|---|---|
| Lilly Cares | Household income at or below 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 links to the page where it is listed.
Sources: pricinginfo.lilly.com, trulicity.lilly.com, lillycares.com, GoodRx.