Does United Healthcare cover Trulicity?

In this article:

• Does UHC cover Trulicity?
• Trulicity cost
• Trulicity cost with UHC
• How to check your coverage
• Factors influencing coverage
• Is UHC good for managing diabetes?
• How to save

In this article

• Does UHC cover Trulicity?
• Trulicity cost
• Trulicity cost with UHC
• How to check your coverage
• Factors influencing coverage
• Is UHC good for managing diabetes?
• How to save

Trulicity (dulaglutide) is a brand-name once-weekly injectable prescription medication known as a GLP-1 receptor agonist. Trulicity, which belongs to the same drug class as Ozempic (semaglutide) and Victoza (liraglutide), is FDA-approved to improve blood sugar levels in adults and children aged 10 years and older with Type 2 diabetes. The FDA also approves this medicine to reduce the risk of major adverse cardiovascular events (heart attack, stroke, and cardiovascular death) in adults with Type 2 diabetes and cardiovascular disease or multiple risk factors for heart disease. Many insurance plans provide coverage for Trulicity, although specific plan details vary, and prior authorization is often required. 

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Does United Healthcare cover Trulicity?

Trulicity is often covered by United Healthcare (UHC) when prescribed for an FDA-approved use. For example, your plan may cover Trulicity for Type 2 diabetes but not for an off-label use (a non-FDA-approved use) such as weight loss. According to Trulicity’s manufacturer Eli Lilly, most commercial plans—such as those through an employer—do provide coverage for Trulicity. 

It’s challenging to provide a definitive “yes” or “no” answer regarding whether United covers Trulicity. Insurance companies offer various plans, and each health plan has its own formulary, a list of covered drugs and their corresponding pricing tiers. The best way to determine if your specific UnitedHealthcare plan covers Trulicity is to check the most recent formulary for your plan. There are also often prior authorization requirements, meaning that your healthcare provider will need to submit paperwork to your insurance company explaining why you need this medication. 

We were able to find some general information regarding United’s coverage of Trulicity, but to confirm, you’ll want to check with your specific plan. A document entitled “UnitedHealthcare Pharmacy Clinical Pharmacy Programs” notes that a 12-month authorization may be approved for individuals who meet specific criteria, which must be submitted by the healthcare provider, including medical records that confirm a diagnosis of Type 2 diabetes and supporting laboratory results. A renewed prior authorization may be required after this time in order for the insurance to continue covering Trulicity. 

Another United document lists the drugs that are covered in 2025, noting that Trulicity requires prior authorization and is classified as a Tier 3 drug (defined as a mid-range cost medication). And a Medicaid plan that is administered through UHC has Trulicity listed as a Tier 1 drug with $0 copay, although a prior authorization is required. It’s important to note that Medicaid plans may vary by state, though. 

Bottom line: Your plan may cover Trulicity if you fit the criteria for use. The prescription will usually require prior authorization. You can contact your specific plan directly to inquire about coverage and your out-of-pocket costs. 

How much does Trulicity cost?

Without insurance or discounts, an average one-month supply of Trulicity—four, 1.5 mg/0.5 ml pens—costs about $1,399. 

How much does Trulicity cost with United Healthcare?

It’s challenging to determine an average copay, as plans vary significantly in their coverage and costs. Moreover, there are several other considerations, including deductibles, coinsurance, and the coverage phase. Because insurers continually update their formularies, the best way to determine your costs is to contact your health insurance plan directly or check the current United Healthcare formulary for your specific plan.

How to check whether your United Healthcare plan covers Trulicity 

To find out whether your specific United Healthcare plan covers Trulicity, you can:

• Contact your insurance plan directly. When you call, have your member ID number and group number ready for the representative. They can look up coverage and costs for Trulicity. 
• Log in to your member account on the UnitedHealthcare website and find the current formulary. Search for Trulicity on the formulary list to find out more about coverage.
• Have your healthcare professional send the Rx to your preferred pharmacy. There, the pharmacy staff can submit the prescription to your plan electronically. They will be able to tell you right away if Trulicity is covered, requires a prior authorization, or is not covered at all. If a PA is required, the pharmacy may initiate the process by sending the forms to your healthcare provider for completion. 

Factors influencing UHC Trulicity coverage

Experts are increasingly recommending GLP-1s like Trulicity as a first choice of therapy. 

However, like all insurance plans, several factors go into determining whether UHC will cover your Trulicity Rx, such as:

• Reason for prescription: Insurers typically cover medicines for FDA-approved uses. Trulicity is FDA-approved for Type 2 diabetes and cardiovascular risk reduction in certain patients. If your healthcare provider prescribes Trulicity for an off-label use, it may be less likely to be covered by your insurance. 
• Prior authorization: With prior authorization, your healthcare professional must submit documentation to the insurance plan. They will want information and supporting records as to why you need this medication. From there, the insurer will make a coverage decision. 
• Formulary tier: Formularies with tiers place drugs into groups mostly based on cost. Formularies typically have three to five tiers, and each plan decides which drugs fall into which tiers based on negotiations with drug companies and other cost factors. Drugs in Tier 1 are the lowest-priced drugs, with prices increasing at higher tiers. 
• Quantity limits: Many insurance plans also have quantity limits. For example, the United formulary notes that Trulicity is covered at Tier 1, with $0 copay for Medicaid patients, and they also limit the quantity to a maximum of four pens every 28 days (which is a typical one-month supply).
• Step therapy: Sometimes insurance plans require step therapy. For example, they may want you to try a lower-cost medication (such as metformin) before they cover a more expensive one, like Trulicity. 

Is UHC good for managing diabetes?

UHC, like many other health insurance plans, offers access to an extensive network of healthcare providers who are qualified to manage diabetes and related medical conditions. UHC also covers a wide range of diabetes medications, as shown in its published formularies. 

UHC also offers various clinical and disease management support groups, including diabetes. UHC’s Diabetes Disease Management support program offers services such as tracking progress on an app, learning strategies to manage your blood sugar, and working with coaches. You can find out more about these programs by logging into your account or calling the phone number on your member ID card. 

How to save on Trulicity

Using a SingleCare discount is one of the best ways to save on Trulicity, as well as all of your other medications. SingleCare is accepted at over 35,000 pharmacies in the United States and Puerto Rico. The discount is free and easy to use, and you can use it every time you fill your prescription. For example, a typical one-month supply (four, 1.5 mg/0.5 ml pens) of Trulicity costs about $1,399 without insurance or discounts. However, if you use a free SingleCare discount card or coupon, you can pay as low as $777 per month, a savings of $622 each month. You can also read about more ways to save money on Trulicity here.