GlucaGen

Generic: glucagon (rDNA)

1 MG

Antihypoglycemic Agent

Also known as: glucagon (rDNA)
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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: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 19 hours, 9 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Complete Gold
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Everyday Bronze
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Elite Bronze
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Silver
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Gold
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Silver + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Gold + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Elite Bronze + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via glucagon (rDNA) 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Complete Gold Tier 4 - Non-Preferred — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze Tier 4 - Non-Preferred — — ✓ QL
Clear Silver with $0 Insulin Options Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze Tier 4 - Non-Preferred — — ✓ QL
Standard Silver Tier 4 - Non-Preferred — — ✓ QL
Standard Gold Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Focused Silver with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Complete Gold with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Standard Silver with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Standard Gold with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Complete Gold + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Silver + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Gold + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 19 hours, 9 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via glucagon (rDNA) 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP)
via glucagon (rDNA) 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via glucagon (rDNA) 		Tier 1 - Preferred Generic — — — None
HealthSpring Preferred Select (HMO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S001 (PPO D-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S2 (PPO D-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Signature (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Guardian (HMO-POS I-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Freedom (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Liberty (HMO-POS)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Champion (HMO-POS C-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
HealthSpring True Choice (PPO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred (HMO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Savings (HMO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Plus (HMO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Plan I (PPO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Plan II (PPO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Vitality Plan (PPO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — — None
Troy Medicare (HMO)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — ✓ 4 per 30 days QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — ✓ 4 per 30 days QL
AmeriHealth Caritas VIP Care (HMO D-SNP)
via glucagon (rDNA) 		Tier 3 - Preferred Brand — — ✓ 4 per 30 days QL
Blue Medicare PPO Enhanced (PPO)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Alignment Health AVA (PPO)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Alignment Health Platinum Select (HMO)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Alignment Health smartHMO (HMO)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Alignment Health Platinum (HMO)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Healthy Blue + Medicare (HMO-POS D-SNP)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Experience Health Medicare Advantage (HMO)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Blue Medicare Essential (HMO)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Blue Medicare Choice (HMO)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Blue Medicare Enhanced (HMO-POS)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
Blue Medicare Essential Plus (HMO-POS)
via glucagon (rDNA) 		Tier 4 - Non-Preferred — — ✓ 4 per 30 days QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via glucagon (rDNA) 		Tier 6 - Specialty Plus — — — None
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