Does Medicare cover Trulicity in Florida?

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 Florida Medicaid, SSI or a Medicare Savings Program (QMB, SLMB or QI-1, which you apply for through ACCESS Florida, run by the Department of Children and Families). Otherwise, apply through Social Security at ssa.gov/extrahelp or 1-800-772-1213 (TTY 1-800-325-0778). Florida has no state drug-assistance program for seniors, so Extra Help is the main public help with Part D costs. See Extra Help in Florida and does Florida have a state drug program for seniors?

Getting Trulicity covered in Florida

Florida is its own Part D region (PDP Region 11), so each standalone Part D plan sold here is offered in all 67 counties. For 2027, CMS lists 11 standalone Part D plans from 6 companies in Florida. Every county also has Medicare Advantage plans open to everyone, from 7 in Monroe County to 52 in Hillsborough 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 Florida counties.

Hurricane season: Trulicity belongs in the refrigerator. The label allows each pen to stay at room temperature, up to 86°F, for a total of 14 days, and says not to use a pen that has frozen. Before a storm, ask your pharmacy whether you can pick up your next pens early. Medicare.gov says that if you live in a declared disaster area, your drug plan can help you find another in-network pharmacy, replace drugs that were lost, damaged or left behind when you evacuated, and fill prescriptions at an out-of-network pharmacy when you can't reasonably reach a network one (keep your receipts). CMS guidance also expects Medicare drug plans to lift "refill-too-soon" limits after a federal disaster declaration. Florida's emergency-refill law (s. 252.358) makes insurers and HMOs licensed by the Office of Insurance Regulation allow early refills when your county is under a hurricane warning or a state of emergency, but it doesn't mention Medicare, so ask your Medicare plan directly. See early refills before a hurricane.

State Group Insurance retirees: if you keep State of Florida retiree coverage once you have Medicare, the State's secondary PPO or HMO plan includes prescription drug coverage the State says is creditable (as good as Part D), so you don't need a separate Part D plan, and the State's group Medicare Advantage (MA-PD) plans include Part D. Either way, Trulicity follows the State plan's drug rules. The State says a retiree who cancels State coverage can't re-enroll later, so call People First (866-663-4735) before joining any outside Medicare plan. See Florida state retirees and Medicare.

Medicare and Florida Medicaid: if you have full Medicaid and Medicare, your Medicare drug coverage, not Medicaid, pays for Part D drugs like Trulicity, and you get Extra Help automatically. In Florida, people with Medicare usually get full Medicaid through SSI, Medically Needy (share of cost) or long-term-care Medicaid: MEDS-AD, the program for aged and disabled adults, leaves out people on Medicare unless they're getting nursing-home, hospice or home and community-based care. See Florida Medicaid and Medicare.

Plans ending in 2027: at least 302,773 Floridians in regular Medicare Advantage plans that are leaving or ending must choose new coverage for 2027. If yours is one, 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.

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 strength 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 Florida?

Sources

• National Library of Medicine — DailyMed: Trulicity prescribing information (FDA label, including storage)
• CMS — Selected drugs for initial price applicability year 2028 (fact sheet, January 2026)
• Medicare.gov — Medicare GLP-1 Bridge
• Florida Division of State Group Insurance — Frequently asked questions: retirees (Medicare, Part D, re-enrollment)
• Florida DCF — ESS Program Policy Manual, chapter 2000 (MEDS-AD, QMB, SLMB, QI-1)
• Medicare.gov — Drug coverage (Part D)
• CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program; data file of November 2, 2026)
• 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 11: Florida)
• Medicare.gov — Getting drugs in a disaster or emergency
• CMS — Pharmacy access during a federal disaster declaration: Q&As for Part D plan sponsors (2017)
• Florida Statutes — s. 252.358, emergency prescription refills

Frequently asked questions

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