Does Medicare Cover Trelegy Ellipta?

Which part of Medicare covers Trelegy?

Trelegy Ellipta is covered under Medicare Part D, the prescription drug benefit. It is not covered under Original Medicare Part A (hospital) or Part B (medical). The reason is simple: Trelegy is a self-administered inhaler that you use yourself at home.

Part D is the part of Medicare designed to cover the brand-name and generic drugs you fill at a pharmacy and take on your own. Original Medicare Part B only covers a limited set of outpatient drugs that you would not normally give yourself, such as certain medications administered in a doctor's office. Everyday inhalers like Trelegy fall outside that narrow Part B set, which is why they belong to Part D instead.

If you have Original Medicare and want coverage for Trelegy, you must enroll in either a standalone Part D drug plan or a Medicare Advantage plan that includes drug coverage (often called an MA-PD plan).

• Part A (hospital): does not cover Trelegy.
• Part B (medical): does not cover Trelegy or most outpatient inhalers.
• Part D (drug plan) or a Medicare Advantage plan with drug coverage: this is where Trelegy is covered.

Coverage and cost depend on your plan's formulary

Having Part D does not automatically mean every drug is covered the same way. Each Part D and Medicare Advantage drug plan publishes its own formulary, which is the list of drugs it covers. Whether a plan covers Trelegy, which tier it places the drug on, and how much you pay all vary from plan to plan.

Tier placement matters because it usually determines your copay or coinsurance. A drug on a lower tier generally costs you less out of pocket than the same drug on a higher specialty or non-preferred tier. Because plans design their own tiers, the same Trelegy prescription can cost different amounts depending on which plan you have.

Plans may also apply utilization management to Trelegy. This can include prior authorization (your plan must approve the prescription before it is covered) or step therapy (you may need to try a lower-cost alternative inhaler first). These rules are set by each plan and are listed in the plan's formulary, so the only reliable way to know is to check the plan you have or are considering.

How to find out if your plan covers Trelegy

Because coverage varies, confirm Trelegy on your own plan before assuming anything. Here are reliable ways to check:

• Use the Plan Finder at Medicare.gov, enter Trelegy as one of your drugs, and compare how plans in your area cover it, including tier, estimated cost, and any restrictions.
• Look up your plan's formulary directly on your insurer's website and search for Trelegy Ellipta.
• Call the member services number on the back of your plan card and ask whether Trelegy is covered, what tier it is on, and whether prior authorization or step therapy applies.
• Ask your pharmacist to run Trelegy through your plan to see your real copay and whether any approvals are needed.

What Trelegy costs with Medicare

Your out-of-pocket cost for Trelegy depends on your plan's tier and cost-sharing, your deductible status, and how much you have already spent during the year. There is no single Medicare price that applies to everyone.

There is an important protection in place. In 2026, Part D out-of-pocket spending on covered drugs is capped at $2,100 for the year. Once your spending on covered Part D drugs reaches that cap, you pay $0 for covered Part D drugs for the rest of the calendar year. For an expensive maintenance drug like Trelegy, this cap limits how much you can be exposed to in a single year.

To have drug coverage at all, you pay a monthly Part D premium. The 2026 national base beneficiary premium is $38.99 per month, though actual plan premiums vary above or below that figure depending on the plan you choose.

• 2026 Part D out-of-pocket cap: $2,100 per year, after which you pay $0 for covered Part D drugs.
• 2026 Part D national base beneficiary premium: $38.99 per month (actual plan premiums vary).
• Your Trelegy copay depends on your plan's tier, your deductible, and where you are in the year.

Trelegy and the Medicare negotiated price (2027)

Trelegy Ellipta was selected for the Medicare Drug Price Negotiation Program for the initial price applicability year 2027. Under that program, Medicare negotiated a maximum fair price of $175 for a 30-day supply, down from a $654 list price, which is roughly a 73% reduction. The negotiated price takes effect January 1, 2027.

Trelegy was included partly because it is so widely used. About 1.3 million Medicare Part D enrollees used Trelegy Ellipta, accounting for roughly $5 billion in total Part D gross covered drug costs. That heavy use among people managing COPD and asthma is one reason the drug was a candidate for negotiation.

Keep in mind the negotiated maximum fair price is not necessarily the same as your personal copay. Your plan still determines your cost-sharing, but the negotiated price is designed to lower the underlying cost of the drug starting in 2027.

Getting help with costs and possible alternatives

If you have limited income and resources, you may qualify for Extra Help, also called the Part D Low-Income Subsidy (LIS). Extra Help can lower or eliminate your Part D premiums, deductibles, and copays, which reduces what you pay for drugs like Trelegy. In 2025-2026, eligibility is generally available up to 150% of the federal poverty level, subject to resource limits.

It also pays to enroll in drug coverage on time, even before you need Trelegy. The Part D late enrollment penalty is 1% of the $38.99 national base beneficiary premium times the number of full months you went without creditable drug coverage, rounded to the nearest $0.10, and it is added to your premium for as long as you have Part D. Signing up when you are first eligible avoids that ongoing penalty.

Finally, ask your prescriber and plan whether a lower-cost alternative inhaler is appropriate. Some plans prefer other inhalers and may require you to try them first through step therapy. Whether Trelegy is the right choice, and whether it is prescribed for COPD or asthma, is a medical decision between you and your doctor; the coverage rules above apply regardless of which condition it is prescribed for, but your specific plan's formulary restrictions still govern what is covered.