Does Blue Cross Blue Shield cover Trulicity?

In this article:

• Does Blue Cross Blue Shield cover Trulicity?
• How much is Trulicity without insurance?
• How much does Trulicity cost with BCBS?
• How to check whether your BCBS plan covers Trulicity
• How to save on Trulicity

In this article

• Does Blue Cross Blue Shield cover Trulicity?
• How much is Trulicity without insurance?
• How much does Trulicity cost with BCBS?
• How to check whether your BCBS plan covers Trulicity
• How to save on Trulicity

Trulicity (dulaglutide) is a brand-name prescription drug known as a glucagon-like peptide-1 receptor agonist, or GLP-1. Trulicity is a once-weekly injection that’s approved by the Food and Drug Administration (FDA) to control blood sugar in people 10 and older with Type 2 diabetes and to reduce the risk of heart attack, stroke, and heart failure in adults with both Type 2 diabetes and cardiovascular disease. Health insurance plans typically cover Trulicity.

Does Blue Cross Blue Shield cover Trulicity?

Although prescription drug coverage varies by plan, Trulicity is covered by most Blue Cross Blue Shield (BCBS) plans, regardless of whether they’re employer-sponsored or part of Medicare or Medicaid.

Some plans may require prior authorization before they cover expensive medications like Trulicity. If your plan requires prior authorization, your healthcare provider will send some information to the insurance company to explain why you need Trulicity. There’s a chance your prescription will be denied if you don’t meet the requirements.  

According to Jennifer Brown, a physician who’s board-certified in obesity medicine and family medicine, it’s unusual for BCBS to require prior authorization for Trulicity. “In my experience, it’s rarely required. Since Trulicity is a very effective treatment for Type 2 diabetes, insurance companies typically cover the cost without question.” 

However, with the rising interest in using GLP-1s off-label for weight loss, new prior authorization requirements may be Blue Cross Blue Shield’s way of addressing drug shortages and keeping overall costs low. If your prior authorization is denied, you or your healthcare provider can appeal the decision. 

Health plans may insist on step therapy, meaning that a less expensive treatment option must be tried before Trulicity will be covered. BCBS may also impose quantity limits on Trulicity. Typically, you can only get a month’s supply at a time. This may be another effort to curb drug shortages. 

How much is Trulicity without insurance?

Without insurance, Trulicity costs around $1,408 for 4, 0.5 mL of 1.5 mg/0.5 mL pens. This is about the same price as other brand-name GLP-1 receptor agonists like Ozempic (semaglutide), Victoza (liraglutide), and Mounjaro (tirzepatide). Drug prices fluctuate and vary by pharmacy and location.

How much does Trulicity cost with BCBS?

The cost of Trulicity with BCBS depends on the cost-sharing structure of your specific health plan. Prescription medications are assigned a tier number, and you typically pay a different copay or coinsurance for each tier. Trulicity is usually listed as a tier 2 or tier 3 drug in BCBS formularies. The higher the tier, the higher the copay.

Here are a few examples. Let’s say you have the Anthem Blue Cross Blue Shield Silver Pathway HMO 3500 plan, which covers Trulicity as a tier 2 drug. The front of your insurance card says you pay 10% coinsurance for tier 2 drugs. So, your out-of-pocket costs would be about $140 for 4, 0.5 mL of 1.5 mg/0.5 mL Trulicity pens.

If you have the Blue Medicare Essential Plus plan out of North Carolina, your formulary classifies Trulicity as a Tier 3 drug. According to your plan documents, you have a $45 copay for a 30-day supply of a Tier 3 drug, so you’d pay $45 every month for Trulicity. 

On the other hand, people with the Anthem Blue Cross and Blue Shield Bronze Pathway HMO 9200 pay 0% coinsurance for all drug tiers, so they would get Trulicity at no additional cost. 

Note that these rates are only available if you buy Trulicity at an in-network pharmacy. If you go to a pharmacy that isn’t in BCBS’s network, you’re expected to pay either a higher copay or Trulicity’s full retail price. 

How to check whether your BCBS plan covers Trulicity 

To find out if your BCBS plan covers Trulicity, call the customer care number on your insurance card. A BCBS representative can answer your coverage questions and tell you how much you’d have to pay out-of-pocket when collecting your prescription. 

You can also log in to your BCBS account portal and view your plan’s documents. First, look for the drug list or formulary. Some BCBS affiliates offer a searchable drug list, while others provide a downloadable PDF. 

The formulary will list which tier Trulicity falls under. Once you have that information, find your Summary of Benefits document or look at the front of your insurance card to learn how much you owe according to Trulicity’s drug tier. 

How to save on Trulicity

If your BCBS health insurance plan doesn’t cover Trulicity, you don’t have to pay the full retail price.

For example, a SingleCare prescription discount card could save you around $600 on a month’s supply of Trulicity, or about 45%. Here’s how it works:

1. Type Trulicity in the search bar.
2. On the Trulicity drug page, click on the location pin and enter your ZIP code.
3. Compare prices at participating pharmacies, and choose one. If you don’t see your past pharmacy on the list, they don’t accept SingleCare coupons.
4. Click “Get free coupon.”
5. Text, email, or print your unique discount code.
6. Ask your healthcare provider to send your Trulicity prescription to the pharmacy you selected.
7. Show the discount code to the pharmacist when you pick up the prescription.

To lower your out-of-pocket expenses even more, Dr. Brown says you may need to consider a different GLP-1 or a different Type 2 diabetes treatment. “Victoza (liraglutide) is the only GLP-1 medication that’s available in a generic form. It would be a less expensive option for those who pay out of pocket for Trulicity. Older, non-GLP-1 medications, such as metformin, would also be less costly but less effective.” 

Learn other ways to save on Trulicity.