Flexichamber

Generic: , assist devices

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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 19 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect myDiabetesCare Silver
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3500 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 4400 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3500 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 4400 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3500 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 4400 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3500 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 4400 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 4400 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3500 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 4400 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
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