Trulicity Shortage: What Providers and Prescribers Need to Know in 2026

Trulicity (dulaglutide) has been on the FDA's drug shortage list since August 2022 — and as of 2026, it remains there. For clinicians managing patients with type 2 diabetes, this ongoing shortage has created real clinical challenges: patients unable to fill prescriptions, breaks in therapy, and complex decisions about when and how to switch medications. This guide provides a practical clinical framework for navigating the Trulicity shortage in 2026.

Current Shortage Status and Underlying Causes

The Trulicity shortage originated in 2022 as a demand-driven event: unprecedented Ozempic demand caused patient switching that overwhelmed dulaglutide production capacity. By early 2025, Eli Lilly disclosed a second contributing factor — manufacturing-related supply constraints independent of demand. These twin pressures, combined with Eli Lilly's strategic investment in tirzepatide (Mounjaro/Zepbound) over dulaglutide, have made this one of the most prolonged GLP-1 shortage events.

Key facts for clinical practice:

• The 3 mg and 4.5 mg doses remain the most affected. Lower doses (0.75 mg, 1.5 mg) have improved availability but are still intermittently short.

• Unlike injectable semaglutide and tirzepatide, dulaglutide shortage has not resolved as of 2026.

• Supply varies significantly by geography and pharmacy. Real-time availability can change week to week.

Clinical Considerations When Trulicity Is Unavailable

When a patient cannot fill their Trulicity prescription, the clinical decision depends on several factors:

• Indication: Is dulaglutide being used primarily for glycemic control, for MACE risk reduction, or both? This determines the urgency and choice of substitute.

• Current A1C: Patients near their A1C goal have more flexibility; those with poorly controlled T2DM need a rapid therapeutic bridge.

• Cardiovascular risk: For patients using Trulicity for proven MACE reduction, switching to another GLP-1 with cardiovascular outcomes data (semaglutide or liraglutide) is appropriate.

• Formulary and insurance: Coverage varies by plan; some alternatives may require prior authorization.

Therapeutic Substitution Options for Dulaglutide

The following GLP-1 receptor agonists are appropriate for therapeutic interchange depending on patient-specific factors:

• Semaglutide SC (Ozempic) 0.25–2 mg weekly: Superior A1C and weight outcomes vs. dulaglutide. Proven MACE reduction (SUSTAIN-6). Initiate 7 days after last dulaglutide dose. Start at 0.25 mg regardless of dulaglutide dose (dulaglutide 0.75 mg ≈ semaglutide 0.25 mg). Shortage largely resolved.

• Tirzepatide (Mounjaro) 2.5–15 mg weekly: Dual GLP-1/GIP agonism. Superior to dulaglutide in A1C and weight reduction (SURPASS-2). Cardiovascular outcomes data available. Shortage resolved Dec 2024. Higher cost; may require prior auth.

• Liraglutide (Victoza) 0.6–1.8 mg daily: Once-daily dosing. Proven MACE reduction (LEADER trial). Generic liraglutide now available at significantly lower cost. Appropriate for patients with CVD history or high CV risk who also have cost barriers.

• Oral semaglutide (Rybelsus) 3–14 mg daily: For injection-averse patients or those where a short-term bridge is needed. Less effective than SC semaglutide at equivalent doses. Must be taken fasting with a small amount of water.

Dose Equivalency Notes for Switching

When initiating semaglutide SC after discontinuing dulaglutide, published guidance suggests starting at 0.25 mg semaglutide 7 days after the last dulaglutide dose. The SUSTAIN 7 trial compared dulaglutide 0.75 mg vs. semaglutide 0.5 mg, and dulaglutide 1.5 mg vs. semaglutide 1.0 mg. These comparisons can guide approximate dose equivalence, though individual titration is always necessary.

For the 3 mg and 4.5 mg dulaglutide doses (where shortage is most severe), some clinical guidance suggests that two 1.5 mg dulaglutide injections per week may serve as a temporary alternative when these strengths are unavailable, as this dosing schedule was used in a Phase 2 study. However, this should be a carefully considered clinical decision made in consultation with the patient.

Patient Counseling Points During the Shortage

• Advise patients to contact your office immediately if they cannot fill their prescription — not after they've missed doses.

• Encourage patients to call multiple pharmacies and to start searching 1-2 weeks before their supply runs out.

• Warn patients explicitly against purchasing compounded or counterfeit dulaglutide — these products are not FDA-reviewed for safety or efficacy.

• For patients at highest risk (recent MACE, very high A1C, or CKD), prioritize securing a therapeutic alternative rapidly rather than waiting for Trulicity to return to stock.

Resources for Providers and Their Patients

• medfinder for Providers: medfinder calls pharmacies near your patient to locate Trulicity in stock, so your staff doesn't spend time on hold. Patients receive results by text.

• Eli Lilly Supply Information: supply.lilly.com provides updated availability data directly from the manufacturer.

• ASHP Shortage Database: The American Society of Health-System Pharmacists maintains a detailed shortage bulletin for dulaglutide with regular updates.

Clinical Bottom Line

Proactive management is the key to protecting your patients during the Trulicity shortage. Identify which patients are at highest clinical risk if therapy is interrupted, counsel all Trulicity patients about the shortage and their options, and have a clear plan for therapeutic substitution when needed. For more provider-specific guidance, see our article on how to help your patients find Trulicity in stock.