Freestyle Libre 3 Sensor Plus
STR N/A — Device
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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.
TRICARE
1 plan| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| TRICARE Uniform Formulary 2026 | Tier 2 - Brand Formulary | — | ✓ | ✓ FREESTYLE LIBRE 3 SENSOR PLUS TO DISP AT MAX QTY OF 2 SENSORS PER DISP AT RTL OR 6 SENSORS AT MAIL | ST | QL Step therapy: SELECT CGM AGENTS W/O USE OR W/O USE OF INSULINS, XULTOPHY 100-3.6,SOLIQUA 100-33 IN 180DAYS REQ PA; Quantity limit |