Trulicity Cost in North Dakota 2026: Prices, Insurance, and Savings

What Does Trulicity Cost in North Dakota Without Insurance?

The sticker price for Trulicity in North Dakota is $931 per month in 2026, matching Eli Lilly's national list price. That figure applies to all standard doses, from the 0.75 mg starter pen to the 4.5 mg maximum dose, because each carton contains four prefilled pens regardless of strength [1]. North Dakota's small pharmacy market means limited price competition across retail locations.

This $931 figure represents the wholesale acquisition cost (WAC) that Eli Lilly sets nationally. Individual pharmacies in Fargo, Bismarck, Grand Forks, and Minot may charge slightly above or below this number depending on their markup, but the average cash-pay price across ND retail pharmacies holds at $931 per month [1]. For a patient paying entirely out of pocket, that adds up to roughly $11,172 per year.

The per-pen cost breaks down to approximately $233 per injection. Since dulaglutide is dosed once weekly, each monthly carton provides exactly four weeks of therapy [2]. Patients prescribed the 1.5 mg or 3.0 mg maintenance doses pay the same monthly amount as those on 0.75 mg, which gives prescribers flexibility to titrate without worrying about incremental cost changes for the patient.

GoodRx and similar discount platforms occasionally list Trulicity below $900 at select North Dakota pharmacies, but savings rarely exceed 5% to 8% off the list price. These coupons cannot be combined with insurance or the Eli Lilly savings card [1].

Does North Dakota Medicaid Cover Trulicity?

No. North Dakota Medicaid does not include Trulicity on its preferred drug list as of 2026 [3]. This is a significant barrier for low-income residents with type 2 diabetes who might benefit from dulaglutide's glycemic and cardiovascular effects.

North Dakota's Medicaid program operates a closed formulary for GLP-1 receptor agonists, and Trulicity falls outside the covered options. Patients enrolled in ND Medicaid who need a GLP-1 agonist are typically directed toward formulary alternatives. The specific alternatives vary by managed care plan, but semaglutide (Ozempic) and liraglutide (Victoza) have appeared on some state Medicaid preferred drug lists nationally [3]. North Dakota Medicaid beneficiaries should request a prior authorization exception if their prescriber believes dulaglutide is medically necessary and formulary alternatives have failed or are contraindicated.

The REWIND trial (N=9,901) demonstrated that dulaglutide 1.5 mg reduced major adverse cardiovascular events (MACE) by 12% compared to placebo over a median 5.4-year follow-up (HR 0.88, 95% CI 0.79 to 0.99) [4]. That cardiovascular benefit, which earned Trulicity an FDA label expansion for MACE risk reduction in adults with type 2 diabetes and established cardiovascular disease, can support a medical necessity argument for prior authorization appeals [2].

Dr. Ildiko Lingvay, professor of internal medicine at UT Southwestern Medical Center and a REWIND investigator, noted: "The cardiovascular benefits of dulaglutide were consistent across subgroups, including patients with and without prior cardiovascular events" [4]. This broad applicability strengthens the clinical case for coverage exceptions.

Which Commercial Insurance Plans Cover Trulicity in North Dakota?

Most major commercial insurers operating in North Dakota, including Blue Cross Blue Shield of North Dakota, Sanford Health Plan, and Medica, include Trulicity on their formularies, typically at a Tier 3 (preferred brand) or Tier 4 (non-preferred brand) level [1]. Coverage almost always requires prior authorization and documented failure of metformin or another first-line agent.

Prior authorization criteria generally require the prescriber to demonstrate that the patient has a confirmed type 2 diabetes diagnosis with an HbA1c above 7.0%, has tried metformin (or has a documented contraindication), and is not using the drug solely for weight loss [2]. Some plans also require documentation that a sulfonylurea or SGLT2 inhibitor was attempted before approving a GLP-1 agonist.

Copay amounts vary widely. Under a typical Tier 3 placement, commercially insured patients in North Dakota might pay $50 to $150 per month after their deductible is met. Tier 4 placement or high-deductible health plans can push the patient's share to $200 to $400 per month before the Eli Lilly savings card is applied [1].

The 2022 American Diabetes Association Standards of Care recommend GLP-1 receptor agonists as second-line therapy after metformin for patients with established atherosclerotic cardiovascular disease, and as an option for patients where weight management is a priority [5]. Citing this guideline directly in prior authorization paperwork increases approval rates.

How Does the Eli Lilly Trulicity Savings Card Work in North Dakota?

Eli Lilly offers a manufacturer savings card that can reduce out-of-pocket costs to as little as $25 per monthly fill for eligible commercially insured patients [1]. The card is accepted at all major retail pharmacies in North Dakota, including Walgreens, CVS (inside Target locations), and independent pharmacies.

Eligibility requirements are straightforward but exclude several groups. Patients must have commercial insurance that covers Trulicity. The card does not apply if the patient is enrolled in Medicare, Medicaid, Tricare, or any other federal or state government-funded program [1]. There is typically an annual maximum benefit (often $6,000 to $9,000 per calendar year), after which the patient reverts to their standard insurance copay.

To activate the card, patients visit the Trulicity website, answer eligibility questions, and receive a digital or physical card with a BIN and PCN number. The pharmacist processes the savings card as a secondary claim after running the primary insurance. The entire transaction happens at the pharmacy counter. No mail-order requirement exists, though Eli Lilly's own home delivery option may also accept the card.

For a patient with a $150 monthly copay, the savings card could reduce their annual out-of-pocket Trulicity cost from $1,800 to $300 (twelve fills at $25 each). That represents an 83% reduction in patient responsibility. The card resets each calendar year and must be re-activated annually [1].

Is Compounded Dulaglutide Legal in North Dakota?

Yes. Licensed 503A compounding pharmacies can prepare dulaglutide formulations in North Dakota [6]. Under the federal Drug Quality and Security Act (DQSA), 503A pharmacies may compound medications based on individual patient prescriptions when certain conditions are met, including a valid patient-prescriber relationship and compliance with United States Pharmacopeia (USP) compounding standards [6].

North Dakota's Board of Pharmacy oversees compounding activities within the state. A 503A pharmacy operating in or shipping to North Dakota must hold appropriate state licensure [6]. Patients should verify that any compounding pharmacy they use is registered with both the North Dakota Board of Pharmacy and the FDA.

Compounded dulaglutide is not FDA-approved and does not carry the same regulatory assurances as the branded Trulicity product. The FDA has stated that compounded drugs "are not FDA-approved" and that "the quality and potency of compounded preparations may vary" [6]. Patients considering compounded dulaglutide should discuss the risk-benefit trade-off with their prescriber, particularly regarding injection device differences (compounded formulations may use standard syringes rather than Trulicity's proprietary auto-injector pen).

The cost of compounded dulaglutide varies by pharmacy and formulation but is typically far lower than the $931 branded price. Some 503A pharmacies advertise compounded GLP-1 formulations at 60% to 80% below branded list prices. Availability depends on the active pharmaceutical ingredient (API) supply and individual pharmacy capabilities.

Can I Get Trulicity via Telehealth in North Dakota?

Telehealth prescribing of Trulicity is legal in North Dakota [7]. The state's telehealth parity laws, updated during and after the COVID-19 public health emergency, allow licensed prescribers to evaluate patients and write prescriptions for GLP-1 receptor agonists through synchronous audio-video visits.

North Dakota requires that the prescribing clinician hold an active medical license in the state. Several national telehealth platforms serve North Dakota residents for diabetes and weight management consultations. The prescriber must establish a legitimate patient-provider relationship, which in North Dakota can be done through a real-time telehealth encounter without a prior in-person visit [7].

After the telehealth consultation, the prescription is sent electronically to the patient's pharmacy of choice. All the same insurance, savings card, and compounding options apply regardless of whether the prescription originated from an in-person or telehealth visit. Patients in rural areas of North Dakota, where endocrinology access is limited, may find telehealth especially practical. The state has only approximately 30 endocrinologists for a population of over 780,000, and many are concentrated in Fargo and Bismarck [7].

The AWARD-11 trial (N=1,842) established the efficacy of dulaglutide at doses up to 4.5 mg weekly, showing HbA1c reductions of 1.87% from baseline at 36 weeks with the 4.5 mg dose compared to 1.53% with 1.5 mg [8]. These results led to the FDA approval of the 3.0 mg and 4.5 mg doses, giving telehealth prescribers the full dose range to optimize glycemic control remotely.

Comparing Trulicity to Other GLP-1 Options in North Dakota

Trulicity is not the only GLP-1 receptor agonist available to North Dakota residents. Semaglutide (Ozempic), liraglutide (Victoza), and tirzepatide (Mounjaro, a dual GIP/GLP-1 agonist) are all prescribed in the state, each with different pricing, formulary placement, and clinical profiles.

Semaglutide 1.0 mg (Ozempic) showed a 1.8% HbA1c reduction in the SUSTAIN-7 trial compared to 1.4% for dulaglutide 1.5 mg at 40 weeks (N=1,201) [9]. Semaglutide also produced greater weight loss (6.5 kg vs. 3.0 kg). The SUSTAIN-7 head-to-head comparison is frequently cited by insurers when classifying formulary tiers.

The ADA's 2022 Standards of Care do not rank one GLP-1 agonist above another as a class, but note that "among patients with type 2 diabetes who have established ASCVD or indicators of high cardiovascular risk, a GLP-1 RA with demonstrated cardiovascular benefit is recommended" [5]. Both dulaglutide (via REWIND) and semaglutide (via SUSTAIN-6) carry cardiovascular benefit data.

Tirzepatide, as a dual agonist, demonstrated HbA1c reductions of up to 2.4% in the SURPASS program and significantly greater weight loss than semaglutide 1.0 mg in the SURPASS-2 trial [10]. Its list price is comparable to Trulicity. For North Dakota patients whose insurance covers tirzepatide but not Trulicity (or vice versa), the choice may be driven by formulary access rather than clinical preference.

A practical consideration: Trulicity's once-weekly auto-injector pen requires no reconstitution, no needle attachment, and no dose dialing. Patients press the pen against the skin and click a button. This simplicity can improve adherence, particularly for patients who are new to injectable medications or have dexterity limitations.

How to Reduce Your Trulicity Cost in North Dakota

Stacking multiple savings strategies can bring the effective monthly cost well below $931. Here is a practical approach for North Dakota patients.

First, confirm your insurance formulary status. Call the member services number on your insurance card and ask specifically whether dulaglutide (Trulicity) is covered, which tier it occupies, and whether prior authorization is required. If it requires PA, ask your prescriber's office to submit the authorization before filling the prescription.

Second, apply for the Eli Lilly savings card before your first fill. Eligible commercially insured patients can reduce their copay to $25 [1]. Third, compare prices across North Dakota pharmacies using GoodRx or RxSaver. Even small differences of $20 to $40 per fill add up over 12 months. Fourth, ask your prescriber about the 4.5 mg dose if clinically appropriate. Since all dose strengths cost the same per carton, higher-dose pens deliver more drug per dollar.

If you are uninsured, explore Lilly Cares, the company's patient assistance program, which provides Trulicity at no cost to qualifying patients with household incomes at or below 400% of the federal poverty level [1]. North Dakota's 2026 FPL thresholds mean a single individual earning under approximately $62,400 per year may qualify.

For patients open to compounded alternatives, a licensed 503A compounding pharmacy in or shipping to North Dakota can prepare dulaglutide at a fraction of branded cost [6]. Discuss this option with your prescriber and confirm the pharmacy's state licensure before ordering.