Trulicity (dulaglutide) is a widely prescribed injectable drug used to manage Type 2 diabetes and reduce the risk of major cardiovascular events in adults. While this once-weekly treatment offers significant health benefits, the cost can be a substantial financial hurdle for many patients without comprehensive insurance coverage. Pharmaceutical companies, government agencies, and non-profit organizations have established various assistance programs to help reduce or eliminate the patient’s out-of-pocket spending. Understanding the specific requirements and mechanisms of these programs is the first step toward accessing this necessary treatment affordably. This guide outlines the distinct routes available to help individuals obtain dulaglutide.
Applying Through the Manufacturer’s Patient Assistance Program
The most direct path to obtaining the medication at no cost is through the manufacturer’s charitable program, the Lilly Cares Foundation Patient Assistance Program (PAP). This program provides free medication to low-income, uninsured individuals, or those with Medicare Part D who face unaffordable costs. Qualification is determined by strict criteria, including household income limits generally set at or below a percentage of the Federal Poverty Level (FPL).
Eligibility often requires the patient’s annual adjusted gross income to fall within certain income brackets, sometimes up to 400% of the FPL, depending on household size. The application process is comprehensive and requires significant involvement from the prescribing healthcare provider. The provider must complete and sign a portion of the forms and provide a current prescription. Documentation verifying the patient’s income, such as tax returns or pay stubs, must also be submitted to the foundation for verification.
The Lilly Cares Foundation has, at times, temporarily paused accepting new applications for Trulicity, only allowing re-enrollment for existing patients. However, the program maintains a special medical exception process for new applicants whose provider can attest to an urgent medical need. This exception ensures patients with pressing circumstances can still access the drug at no cost if they meet all other income and insurance criteria.
Utilizing Savings Cards and Co-Pay Programs
For patients with commercial health insurance, the manufacturer-sponsored savings card reduces the monthly co-payment. This program is distinct from the Patient Assistance Program as it is designed for individuals who already have active insurance coverage, not those who are uninsured or underinsured. The Trulicity Savings Card lowers the patient’s out-of-pocket cost to a minimal amount, often as low as $25 for a monthly supply.
This co-pay assistance is strictly unavailable to patients enrolled in any federal or state government-funded healthcare program, including Medicare, Medicaid, or TRICARE. The program functions by covering a portion of the patient’s co-pay or deductible, allowing them to bypass the full cost-sharing amount. The card’s benefit is subject to both a monthly cap and an annual maximum, which limits the total savings over the course of a year.
Typically, the card provides a maximum benefit amount, such as $150 per month, with an annual limit around $1,800. Once the patient reaches this cap, they become responsible for the full remaining co-pay, even if the program’s expiration date has not been reached. Patients must re-enroll annually to continue receiving the reduced co-pay, remain commercially insured, and be prescribed the medication for an FDA-approved use.
Navigating Government Coverage Options
For many individuals, particularly those over the age of 65 or those with qualifying disabilities, government coverage provides a structured way to manage the cost of dulaglutide.
Medicare Part D and Extra Help
Medicare Part D prescription drug plans frequently include Trulicity on their formularies, though coverage specifics vary depending on the chosen plan and its drug tier classification. Most Part D plans require prior authorization and may enforce step therapy protocols, meaning patients must first try less-expensive, preferred medications before Trulicity is covered.
A substantial portion of Medicare beneficiaries with Part D coverage pay less than $100 per month for the drug, but costs can rise significantly for others, especially before the annual out-of-pocket limit is reached. The Medicare Low-Income Subsidy (LIS), also known as “Extra Help,” offers dramatic cost reduction for qualifying Medicare beneficiaries with limited income and resources. Enrollment in Extra Help can reduce the co-pay for dulaglutide to as little as $4 to $9 per month, making the ongoing cost negligible.
State Medicaid Programs
State Medicaid programs cover outpatient prescription drugs, and Trulicity is generally included for eligible low-income individuals. While coverage is typically provided, it often comes with requirements like prior authorization to ensure the drug is medically appropriate and quantity limits to control usage. Patients should consult their state’s specific Medicaid formulary, as coverage rules and restrictions can differ significantly from one state to the next.
Essential Steps for Successful Enrollment
Successful enrollment in any assistance program requires diligent preparation and coordination between the patient and their healthcare team. The initial step involves gathering all necessary documentation, which universally includes proof of income, copies of insurance cards, and identification. Submitting an incomplete application is the most common cause of processing delays or outright denial.
The prescribing physician’s office plays an important role, as they must often complete portions of the application form and provide a signed, current prescription. Patients should proactively schedule time with their provider’s office staff, such as a nurse or social worker, to ensure these forms are filled out accurately and submitted promptly. If an application is initially denied, patients should immediately inquire about the program’s appeal process.
Resources like hospital social workers, pharmacy staff, or independent patient advocacy groups can provide guidance through the complexities of the various applications. These professionals often specialize in navigating the financial requirements and can help determine which program—the charitable PAP, a co-pay card, or a government subsidy like Extra Help—offers the best avenue for continuous, affordable access to the medication.