Does Blue Cross Blue Shield cover Trulicity?

In this article:

• Does BCBS cover Trulicity?
• How much does Trulicity cost?
• How much does Trulicity cost with BCBS?
• How to check whether your BCBS plan covers Trulicity
• What to do if insurance won’t cover Trulicity
• How to get Trulicity without insurance

In this article

• Does BCBS cover Trulicity?
• How much does Trulicity cost?
• How much does Trulicity cost with BCBS?
• How to check whether your BCBS plan covers Trulicity
• What to do if insurance won’t cover Trulicity
• How to get Trulicity without insurance

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 cardiovascular death in adults with both Type 2 diabetes and cardiovascular disease (or multiple risk factors). Health insurance plans, including many BCBS plans, often cover Trulicity, but coverage varies by individual plan, and prior authorization may be required.

Does Blue Cross Blue Shield cover Trulicity?

Although prescription drug coverage varies by plan, Trulicity is covered by many 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, MD, 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. For example, some plans limit prescriptions to a month’s supply at a time. This may be another effort to curb drug shortages. 

If you have a BCBS plan through Medicare, it’s best to check with your individual plan for coverage details. For example, in one Medicare Plus Blue PPO formulary we reviewed, Trulicity was listed as a tier 3 drug. It also required a prior authorization and had a limit of one box of four pens per month, which is a standard one-month supply.

If your BCBS coverage is through Medicaid, know that Medicaid coverage varies by state. You can contact your state Medicaid plan to find out if Trulicity is covered. For example, if you have Horizon NJ Health, Trulicity is on the formulary, but may require prior authorization or have other limitations.

How much does Trulicity cost?

Without insurance, Trulicity costs around $1,396 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. Trulicity is a brand-name drug, and there is no less expensive generic available at this time. 

 

RELATED: Diabetes resources

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 often 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 a BCBS plan that covers Trulicity as a tier 2 drug with a 10% coinsurance. In this case, 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 may have a $615 annual deductible, and after meeting the deductible, you would pay 25% coinsurance (about $350 per 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 after their deductible is met. 

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 may be 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 picking up 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. 

What to do if insurance won’t cover Trulicity

If your BCBS plan does not initially cover Trulicity, you can ask your healthcare provider to submit a prior authorization. Once they do this, your plan may consider covering Trulicity. If the prior authorization is denied, you can ask your doctor to appeal the decision. If your Trulicity Rx is still denied, you can explore other options with your doctor, such as trying a different GLP-1 drug that may be covered under your plan or using a different diabetes medication that may be suitable for you. 

How to get Trulicity without insurance

If your BCBS health insurance plan doesn’t cover Trulicity, you don’t have to pay the full retail price, even if you are paying without insurance.

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 preferred pharmacy on the list, they don’t accept SingleCare coupons.
4. Click “Get free coupon.”
5. Text, email, or print your unique discount card.
6. Ask your healthcare provider to send your Trulicity prescription to the pharmacy you selected.
7. Show the discount card to the pharmacist when you pick up the prescription.

RELATED: How do I use the SingleCare app?

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. Some examples include a generic GLP-1 such as liraglutide (generic Victoza) or a diabetes medicine from a different class of drugs, such as metformin.  

RELATED: How to save on Trulicity