glucagon (rDNA)
1 MG — Kit
Also known as:
Glucagon Emergency Injection Kit
Glucagon Emergency Injection Solution Reconstituted
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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.
Ambetter (Centene)
58 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Expanded Bronze + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Silver + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Gold + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Focused Silver with Atrium Health
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Complete Gold with Atrium Health
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Expanded Bronze with Atrium Health
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Silver with Atrium Health
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Gold with Atrium Health
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Everyday Bronze + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Elite Bronze + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Complete Gold
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Everyday Bronze
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Elite Bronze
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Clear Silver with $0 Insulin Options
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Expanded Bronze
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Silver
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Standard Gold
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Complete Gold + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via GlucaGen |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Gold Premier + No Referrals | Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Brand-Preferred | — | — | ✓ | QL |
Medicare Part D
63 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 4 per 30 days | QL |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Signature (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Freedom (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Liberty (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring TotalCare (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred Select (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred Savings (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred Plus (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Plan I (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Plan II (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Troy Medicare (HMO) | Tier 3 - Preferred Brand | — | — | ✓ 4 per 30 days | QL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 4 per 30 days | QL |
| Blue Medicare Essential Plus (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Alignment Health Platinum (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Alignment Health smartHMO (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Alignment Health Platinum Select (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Alignment Health AVA (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Experience Health Medicare Advantage (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Blue Medicare Essential (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Blue Medicare Choice (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Blue Medicare Enhanced (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| Blue Medicare PPO Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 4 per 30 days | QL |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| AIAN Cost Share | Tier 2 - Generic | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | Tier 2 - Generic | — | — | — | None |
| Gold Classic Standard | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 2 - Generic | — | — | — | None |
| Silver Classic | Tier 2 - Generic | — | — | — | None |
| Secure | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | Tier 2 - Generic | — | — | — | None |
| Secure | with Atrium Health | Tier 2 - Generic | — | — | — | None |
UnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Bronze Standard (No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Gold Standard (No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Silver Standard (No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |