Does Medicare Cover Trulicity? 

Blood glucose is a measure of the level of sugar in your blood. All kinds of foods can create glucose, and while you may only think that only sweet foods containing a lot of natural sugar are to blame, the body actually produces glucose from sources like carbohydrates as well. For many people, diet and exercise can control blood glucose levels, sometimes measured as HbA1C and referred to simply as A1C.

When A1C levels are too high, diabetes may be the culprit. This is a medical condition in which the pancreas does not produce enough insulin or is unable to process glucose. When both of these things happen at the same time, the result is type II diabetes.

How is diabetes treated?

Diabetes is treated based on the cause and the severity. Diabetics will usually need to test their blood on a regular basis to measure blood glucose levels throughout the day, particularly before meals. This testing usually involves pricking the finger to draw a droplet of blood. The droplet is applied to a testing strip which is then inserted into a special device that can check the level of glucose.

For individuals with high A1C levels, doctors may recommend dietary changes in addition to increased exercise. When these actions aren’t enough, prescription medications may need to be used to control blood glucose levels.

What is Trulicity?

Trulicity (dulaglutide) is a prescription medication produced by Eli Lilly and Company. It is designed to help lower A1C levels in people who experience high blood glucose. Trulicity is usually taken once per week, and when used as directed, it is believed that diabetics may experience A1C levels that fall below 7%.

Does Medicare cover Trulicity?

Medicare supplies coverage for Trulicity through Medicare Part D, the prescription drug benefit. Medicare Part D was added to the Medicare program in 2006, and since then, it has helped millions of Medicare recipients pay for prescription medications for all types of healthcare concerns.

Each Medicare Part D plan includes a formulary that lists the medications covered by the plan. To look up your benefits for Trulicity, you will want to consult your formulary. There, you will see additional information about restrictions or limitations to your Medicare benefits as they pertain to Trulicity or any other prescription drug.

Does Medicare cover diabetic testing supplies?

Diabetics can also receive additional coverage for testing supplies through Medicare Part B. Medicare coverage through Part B provides benefits for outpatient services, but it also covers durable medical equipment (DME).

Certain testing supplies fall under the definition of DME, including test strips, traditional blood glucose monitoring devices and continuous blood glucose monitoring (CGM) devices. Original Medicare benefits will pay for a certain amount of some testing supplies each benefit period, but keep in mind that testing supplies must be purchased from Medicare-approved suppliers in order to qualify. Over-the-counter purchases are usually excluded from Medicare coverage.

Medicare Advantage and Trulicity coverage

Medicare benefits through a Medicare Advantage plan that includes prescription drug coverage should also cover Trulicity as well as diabetic testing supplies. For testing supplies, you will receive the same Medicare coverage as you would with Original Medicare. This means Medicare pays for 80% of your Part B costs while Medicare recipients pay for the remaining 20%. Your costs for Part D prescription drug coverage will be based on your plan provider and plan.

The difference with a Medicare Advantage plan is that you may be able to receive access to healthcare benefits that are not included in Original Medicare benefits. These benefits may include access to fitness plans or additional nutritional counseling designed for people with diabetes. You may also have more flexibility in the purchase of over-the-counter products for diabetics through reimbursement or discount plans.

Each Medicare Advantage plan is different, so you are encouraged to contact your plan provider or work with a Medicare insurance broker to discuss your individual needs.

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