Varies by plan

Does Triple S Advantage, INC. require prior authorization for Trulicity?

Prior authorization for Trulicity differs across Triple S Advantage, INC.'s Medicare Part D plans and product strengths — 3 of 4 Trulicity products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.

Some plans require authorization and others do not. The member's specific plan decides.

This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.

By product strength

RxNorm product	Plans covering	Require prior auth	Qty limit	Status
0.5 ML dulaglutide 1.5 MG/ML Auto-Injector [Trulicity]1551300	22 / 22	22	22	Prior authorization required
0.5 ML dulaglutide 3 MG/ML Auto-Injector [Trulicity]1551306	22 / 22	22	22	Prior authorization required
0.5 ML dulaglutide 6 MG/ML Auto-Injector [Trulicity]2395779	22 / 22	22	22	Prior authorization required
0.5 ML dulaglutide 9 MG/ML Auto-Injector [Trulicity]2395785	0 / 22	0	0	Not on formulary

Product names come from RxNorm (U.S. National Library of Medicine).

Plan-by-plan detail — 0.5 ML dulaglutide 1.5 MG/ML Auto-Injector [Trulicity]

Trulicity has 4 products in the corpus; this table is for 0.5 ML dulaglutide 1.5 MG/ML Auto-Injector [Trulicity], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Ahorro Plus (HMO)	H5774-047	3	Yes	No	Yes
Ahorro Plus (HMO)	H5774-047	3	Yes	No	Yes
Ahorro Plus (HMO)	H5774-047	3	Yes	No	Yes
Ahorro Plus (HMO)	H5774-047	3	Yes	No	Yes
Ahorro Plus (HMO)	H5774-047	3	Yes	No	Yes
Brillante (HMO-POS)	H5774-031	3	Yes	No	Yes
Contigo Plus (HMO C-SNP)	H5774-022	3	Yes	No	Yes
ContigoEnMente (HMO C-SNP)	H5774-046	3	Yes	No	Yes
Enlace Plus (HMO)	H5774-038	3	Yes	No	Yes
PLATINO ADVANCE (HMO D-SNP)	H5774-041	1	Yes	No	Yes
PLATINO ADVANCE (HMO D-SNP)	H5774-041	1	Yes	No	Yes
PLATINO ADVANCE (HMO D-SNP)	H5774-041	1	Yes	No	Yes
PLATINO ADVANCE (HMO D-SNP)	H5774-041	1	Yes	No	Yes
PLATINO ADVANCE (HMO D-SNP)	H5774-041	1	Yes	No	Yes
Platino Blindao (HMO D-SNP)	H5774-028	1	Yes	No	Yes
Platino Enlace (HMO D-SNP)	H5774-035	1	Yes	No	Yes
PLATINO PLUS (HMO D-SNP)	H5774-043	1	Yes	No	Yes
PLATINO PLUS (HMO D-SNP)	H5774-043	1	Yes	No	Yes
PLATINO PLUS (HMO D-SNP)	H5774-043	1	Yes	No	Yes
PLATINO PLUS (HMO D-SNP)	H5774-043	1	Yes	No	Yes
PLATINO PLUS (HMO D-SNP)	H5774-043	1	Yes	No	Yes
�ptimo Plus (PPO)	H4005-004	3	Yes	No	Yes

Source

Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File

Effective: 2026-06-30
Retrieved: 2026-07-19
SHA-256: e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae

We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.

Trulicity at other payers

Or see Trulicity across every payer at once.

Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.