Does Medicare cover Trulicity in North Carolina?

What Trulicity is used for

Trulicity is a once-weekly GLP-1 injection in a single-dose pen. Its FDA label covers improving blood sugar control, with diet and exercise, in adults and children 10 and older with type 2 diabetes, and lowering the risk of heart attack, stroke and cardiovascular death in adults with type 2 diabetes who have heart disease or several heart risk factors.

This page explains Medicare coverage only. Questions about whether Trulicity is right for you belong with your prescriber.

Which part of Medicare covers Trulicity

Trulicity is a pen you use at home, so it's a Part D drug. Federal law keeps drugs used for weight loss alone out of Part D, so plans often attach prior authorization to GLP-1 drugs to confirm they're for diabetes. Your prescriber usually handles that with the plan.

The Medicare GLP-1 Bridge, CMS's temporary weight-management program, doesn't apply here: it doesn't cover Trulicity, and people with type 2 diabetes aren't eligible for it because their Part D plan can cover a GLP-1 for diabetes.

Is Trulicity on Medicare's negotiated-price list?

CMS selected Trulicity on January 27, 2026, for the third round of the Medicare Drug Price Negotiation Program. Negotiations take place during 2026, and prices from this round take effect in 2028, so 2027 coverage works as it does now. Trulicity tops the third-round list: CMS counted about 617,000 people with Medicare who used it from November 2024 through October 2025. A negotiated price (the law calls it the "maximum fair price") is what Medicare drug plans and pharmacies pay; it isn't your copay. What you pay still depends on your plan's cost sharing.

Generics and biosimilars

There's no generic or biosimilar Trulicity; CMS can only select drugs without generic or biosimilar competition. If your plan prefers a different GLP-1 for diabetes, your prescriber can ask for an exception or discuss switching.

What you pay for Trulicity in 2027: the out-of-pocket cap

Your cost for Trulicity depends on your plan: its deductible, the tier it puts the drug on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:

• 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
• The maximum Part D deductible for 2027 is $700. No plan can set a higher deductible.
• Only covered drugs count. If your plan doesn't cover Trulicity and you pay cash, or you use a discount card instead of your plan, that spending doesn't count toward the cap.

Spreading the cost: the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan lets you pay your Part D drug costs in monthly bills from your plan across the calendar year instead of all at once at the pharmacy. Medicare.gov says there's no cost to participate, but it doesn't lower your drug costs; it only changes when you pay. It helps most when your costs are high early in the year. To join, call your plan or use its website. More in What is the Medicare Prescription Payment Plan?

Extra Help with Trulicity

Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have full NC Medicaid, SSI or a Medicare Savings Program, which North Carolina calls MQB (MQB-Q, MQB-B or MQB-E). Otherwise, apply through Social Security at ssa.gov/extrahelp or 1-800-772-1213 (TTY 1-800-325-0778). See Extra Help in North Carolina and MQB in North Carolina.

Getting Trulicity covered in North Carolina

North Carolina is its own Part D region (PDP Region 08), so each standalone Part D plan sold here is offered in all 100 counties. For 2027, CMS lists 11 standalone Part D plans from 6 companies in North Carolina. Every county also has Medicare Advantage plans open to everyone, from 11 in Carteret County to 57 in Guilford County. Each plan has its own formulary, so one plan's coverage of Trulicity tells you nothing about another's. Your county's numbers are on North Carolina counties.

State Health Plan retirees: the Plan's Base Plan and Enhanced Plan are group Medicare Advantage plans that include group Part D, so your Trulicity coverage comes from the Plan's formulary. Don't join a separate Part D or Medicare Advantage plan to get Trulicity covered: the State Health Plan says that removes you from its group Medicare Advantage plan and moves you to the 70/30 Plan. Ask the Plan first. See the State Health Plan and Medicare.

If you have full NC Medicaid and Medicare, your Medicare drug coverage, not NC Medicaid, pays for Part D drugs like Trulicity, and you get Extra Help automatically. See NC Medicaid and Medicare.

If your Medicare Advantage plan ends in 2027, your plan sends a non-renewal letter, and you have a special enrollment period through February 28, 2027. To keep Trulicity covered without a gap, choose new drug coverage by December 31, 2026. See plans ending in 2027.

Hurricanes and power outages: Trulicity has storage-temperature limits on its label, so a long power outage can ruin your supply; keep your plan's pharmacy number with your emergency supplies. CMS says Medicare pays to replace prescription drugs lost, destroyed or damaged in a disaster; call your plan for a replacement fill. North Carolina's emergency-refill law (G.S. 58-3-228) is written for state-regulated health plans and the State Health Plan; in a Medicare drug plan, ask the plan itself. See early refills before a hurricane.

How to check whether a plan covers Trulicity

1. Write down the exact drug. Name, strength and how often you take it. A plan can cover one form of Trulicity and not another.
2. Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Trulicity and any rules.
3. Read the rules next to the drug. Prior authorization, step therapy or quantity limits mean your prescriber may need to send the plan information before it pays.
4. Check your 2027 notice. Your plan's Annual Notice of Change says whether Trulicity stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
5. Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.

If your plan doesn't cover Trulicity, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if your prescriber says waiting could seriously harm your health. New members can usually get a one-time transition supply of a drug they were already taking while they ask for an exception or switch. See How do I appeal a Medicare denial in North Carolina?

Sources

• National Library of Medicine — DailyMed: Trulicity prescribing information (FDA label)
• Medicare.gov — Drug coverage (Part D)
• CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program)
• CMS — Selected drugs for initial price applicability year 2028 (fact sheet, January 2026)
• Medicare.gov — Medicare GLP-1 Bridge
• CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold, deductible and Extra Help copays)
• Medicare.gov — Medicare Prescription Payment Plan
• Social Security — Extra Help with Medicare prescription drug plan costs
• eCFR — 42 CFR 423.120 (formularies and transition fills)
• CMS — Medicare Advantage and Part D Landscape files, 2027 (PDP Region 08: North Carolina)
• State Health Plan — Retiree presentation (group Medicare Advantage plans, outside Medicare plans and the 70/30 Plan)
• CMS — Replacing Durable Medical Equipment and Prescription Drugs after a Disaster
• North Carolina General Statutes — G.S. 58-3-228, extra prescriptions during a state of emergency or disaster

Frequently asked questions

Medicare in your North Carolina county

Plans, local agents and help, county by county: Wake · Mecklenburg · Guilford · Forsyth · Durham · Cumberland · Buncombe · Union · Johnston · Cabarrus · New Hanover · Gaston · Onslow · Iredell · Alamance · Pitt · Davidson · Brunswick · Catawba · Rowan · All 100 counties →