This information is intended for US Residents ages 18 and older.

Trulicity® (dulaglutide)  
 

Pay as little as $25 per prescription

Commercially insured patients may pay as little as $25 for up to 12 pens of Trulicity.

If you have questions, we're here to help. Call The Lilly Answers Center at 1-844-TRU-INFO (1-844-878-4636). You can also call if you fill your prescription through mail order and need reimbursement information. Your card expires for redemption refills on December 31, 2022.

THIS OFFER IS INVALID FOR PATIENTS WHOSE PRESCRIPTION CLAIMS ARE ELIGIBLE TO BE REIMBURSED, IN WHOLE OR IN PART, BY ANY GOVERNMENTAL PROGRAM.

See below for Terms and Conditions and Pharmacist Instructions.

Please click to see Purpose and Safety Summary with Warnings.

RxBIN: 018844
PCN: 3F
Group: TRUDTCEM2
Identification: TALM8857430
Expiration Date: 12/31/2022

Terms and Conditions:

By using the Trulicity Savings ("Card"), you attest that you meet the eligibility criteria, agree to and will comply with the terms and conditions described below:

Offer good until 12/31/2022 for up to 12 months of Trulicity. Patients must have coverage for Trulicity through their commercial drug insurance coverage to pay as little as $25 for up to 12 pens of Trulicity. Offer subject to a monthly cap of $150 and a separate annual cap of $1800. Offer void where prohibited by law. Patient is responsible for any applicable taxes, fees, or amounts exceeding monthly or annual caps. This offer is invalid for patients without commercial drug insurance or whose prescription claims for Trulicity are eligible to be reimbursed, in whole or in part, by any governmental program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DoD, VA, TRICARE®/CHAMPUS, or any state patient or pharmaceutical assistance program. This offer is not valid for: Massachusetts residents if an AB-rated generic equivalent is available; California residents if an FDA-approved therapeutic equivalent is available. Available only in the US and Puerto Rico for residents of the US and Puerto Rico. By accepting this offer, you agree that if you are required to do so under the terms of your insurance coverage for this prescription or are otherwise required to do so by law, you should notify your insurance carrier of your redemption of this Card. This offer cannot be combined or utilized with any other program, discount, discount card, cash discount card, coupon, incentive, or similar offer involving Trulicity. It is prohibited for any person to sell, purchase or trade; or to offer to sell, purchase or trade, or to counterfeit this Card. This offer may be terminated, rescinded, revoked or amended by Lilly USA, LLC at any time without notice. Card activation required. This Card is not health insurance. This Card expires on 12/31/2022.

To the Pharmacist:

  • This card must be accompanied by a valid prescription for Trulicity and can only be used by one patient. By accepting this offer, you certify that you understand and agree to comply with the offer terms set forth herein.
  • If you are required to do so under the terms of your third-party payer contracts or as otherwise required by law, you should notify the affected third-party payer of your redemption of this offer
  • This offer is valid for commercially insured patients only. Offer is not valid for patients who are eligible to have their prescriptions reimbursed in whole or part by any governmental program
  • Please return card to patient after claim is processed
  • Transmit claim online to RxBIN 018844. Processor requires valid Prescriber ID #, PCN, Patient Name, and DOB for claim adjudication
  • Card may be used for up to 14 fills of Trulicity
  • For Insured/Covered Patients - Submit the co-pay authorized by the patient's primary insurance as a secondary claim to Eversana using BIN 018844 and using the Coordination of Benefits fields with Coverage Code type 08. This will reduce the eligible patient's out-of-pocket costs to pay as little as $25, subject to monthly and annual savings caps for the program.
  • Pharmacists with questions, please call the Pharmacy Benefit Manager 1-855-282-4888

Trulicity® is a registered trademark owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates.

Do not reply to this email. If you have a medical emergency, please call 911 or go to your nearest medical facility. If you have a question about a Lilly product, please call 1-800-LillyRx (1-800-545-5979).

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PP-DG-US-4544 06/2022

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