How to Help Your Patients Save Money on Trulance: A Provider's Guide to Savings Programs

Cost is one of the top reasons patients abandon or never start Trulance (plecanatide). With a retail price of approximately $749–$830 for a 30-day supply and no generic equivalent, Trulance sits in an uncomfortable pricing tier for many patients — too expensive to pay for out of pocket, but sometimes difficult to get covered by insurance. This guide gives providers a comprehensive overview of every available savings mechanism, from manufacturer programs to formulary strategies, so you can help more patients stay on therapy.

Why Trulance Cost Is a Persistent Problem

Unlike the situation with many brand medications, Trulance does not have a generic competitor — and won't until at least 2034 based on current patent protection. This extended brand exclusivity keeps list prices high. Compounding the problem:

• Most plans require prior authorization before covering Trulance
• Many payers position Linzess as the preferred GC-C agonist, requiring step therapy for Trulance
• Medicare and Medicaid patients cannot use manufacturer copay cards
• Uninsured patients face full retail prices without assistance programs

Understanding these barriers allows you to take a proactive role in reducing medication abandonment — which is common with high-cost GI medications.

Program 1: Trulance Savings Card (Commercial Insurance)

The Trulance Savings Card from Salix Pharmaceuticals is the most impactful tool available for commercially insured patients. Key clinical and administrative details:

• Patient cost: As little as $25 per prescription fill
• Eligibility: Commercial insurance only — excludes Medicare Part D, Medicaid, VA, TRICARE, and other federal/state programs
• Annual limit: Up to 12 fills per year; maximum savings apply
• Enrollment: Patient enrolls at trulance.com/savings or by calling 1-855-846-2745
• Provider action: Print or share the trulance.com/savings URL at the point of prescribing. A significant percentage of commercial patients are unaware this program exists.

Copay accumulator note: Some insurance plans use "copay accumulator adjusters" that prevent manufacturer copay card amounts from counting toward the patient's annual out-of-pocket maximum. If your patient's plan uses this, they may face a high-deductible phase later in the year even with the copay card. Advise patients to check their plan's copay accumulator policy.

Program 2: Salix Patient Assistance Program

For uninsured patients or those ineligible for the commercial savings card, the Salix Patient Assistance Program (PAP) may provide Trulance at no cost or significantly reduced cost. Eligibility is income-based and subject to periodic revision. Program details:

• Contact: Salix Medical Information at 1-800-321-4576
• Bridge program: A bridge program may be available for patients experiencing a temporary loss or delay in coverage. Contact Salix for current availability.
• Application support: Your staff can initiate the PAP application on the patient's behalf. Third-party services like The Rx Advocates can also assist patients for a monthly fee.

Program 3: Medicare Part D Optimization

For Medicare patients, who cannot use the manufacturer savings card, cost optimization requires a different approach:

• Part D plan comparison: Encourage patients to compare Part D plans annually during open enrollment (October 15 – December 7) using Medicare.gov's plan finder. Some plans cover Trulance at a lower tier than others.
• Extra Help / Low Income Subsidy: Medicare beneficiaries who meet income and resource criteria may qualify for Extra Help (LIS), which subsidizes Part D premiums, deductibles, and copays — potentially reducing Trulance costs substantially.
• Part D cap: As of 2026, Medicare Part D has a $2,100 annual out-of-pocket cap — which means once a patient reaches this limit, their drug costs are covered for the rest of the year. For patients taking multiple expensive medications, reaching this cap may make Trulance cost $0 for part of the year.

Strategy: Optimize Prior Authorization Documentation

Strong PA documentation reduces first-pass denial rates, which is the most direct way to lower patient cost barriers. For Trulance, ensure your PA submission includes:

1. CIC or IBS-C diagnosis with duration (≥3 months or ≥6 months)
2. Documented failure or intolerance of lifestyle modifications
3. Documented trial and failure of OTC osmotic/stimulant laxatives
4. If plan requires step therapy: documented trial and failure/intolerance of Linzess (linaclotide) or another preferred GC-C agonist
5. Absence of GI obstruction
6. Clinical rationale for Trulance vs. preferred alternative (e.g., patient tolerated Linzess poorly due to diarrhea, or food-timing restriction impacted adherence)

Strategy: Consider Mail-Order for Long-Term Patients

For patients who plan to take Trulance long-term, mail-order pharmacy is worth recommending at initiation. Benefits for patients include:

• 90-day supplies at a 2-month equivalent copay (effectively 33% lower per-dose cost)
• Reliable access — mail-order operations don't run out of stock the way retail pharmacies do
• Home delivery — reduces transportation barriers

Ask your practice's MA or nurse educator to include mail-order setup instructions in Trulance after-visit summaries.

When Cost Is Insurmountable: Clinical Alternatives

When cost barriers prove insurmountable despite all programs above, clinical alternatives include:

• Generic linaclotide (Linzess generic): Same drug class as Trulance, now available generically in some markets with substantial cost reduction
• Generic lubiprostone (Amitiza generic): Chloride channel activator; effective for CIC and IBS-C (women); $35–$200/month generic pricing
• Prucalopride (Motegrity): For CIC, when a pro-motility approach is preferred; check formulary as pricing varies

How medfinder Supports Your Practice

Directing your Trulance patients to medfinder for providers helps address the pharmacy access side of the equation. When patients who've navigated insurance successfully still can't find the drug at their local pharmacy, medfinder calls pharmacies in the patient's area and texts them a list of locations that have Trulance in stock. This reduces unnecessary callbacks to your office and keeps patients on the therapy you've worked to get covered.

Key Takeaways for Providers

• Provide the Salix savings card to ALL commercially insured patients at the point of prescribing
• For uninsured patients, initiate the PAP application through Salix (1-800-321-4576)
• Submit prior authorizations proactively with full step therapy documentation
• Recommend mail-order pharmacy for long-term patients to reduce cost and improve access reliability
• Advise Medicare patients on annual Part D plan comparison and Extra Help program eligibility