Gvoke Pfs

Generic: glucagon subcutaneous

1MG/0.2ML — Prefilled Syringe

ANTIDIABETICS

Also known as: GVOKE PFS SOSY 1MG/0.2ML

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: Oct 1, 2026  ·  Checked: 15 hours, 13 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via Gvoke Hypopen 1-Pack
Tier 2 - Preferred Brand — — — None
BCBS Federal Focus 2026 Tier 2 - Preferred Brand — — — None
BCBS Federal Basic Option 2026 Tier 2 - Preferred Brand — — — None
BCBS Federal Standard Option 2026 Tier 2 - Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Gvoke Hypopen 1-Pack
Tier 2 - Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Gvoke Hypopen 1-Pack
Tier 2 - Preferred Brand — — — None
BCBS Federal Focus 2026
via Gvoke Hypopen 2-Pack
Tier 2 - Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Gvoke Hypopen 2-Pack
Tier 2 - Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Gvoke Hypopen 2-Pack
Tier 2 - Preferred Brand — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 15 hours, 13 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via Gvoke Hypopen 1-Pack
Tier 3 - High Cost Brand — — — None
BCBSNC Blue Value 2026
via Gvoke Hypopen 2-Pack
Tier 3 - High Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Gvoke Hypopen 1-Pack
Tier 3 - High Cost Brand — — — None
BCBSNC Blue Local 2026
via Gvoke Hypopen 1-Pack
Tier 3 - High Cost Brand — — — None
BCBSNC Blue Care 2026
via Gvoke Hypopen 1-Pack
Tier 3 - High Cost Brand — — — None
BCBSNC Blue Value 2026
via Gvoke Hypopen 1-Pack
Tier 3 - High Cost Brand — — — None
BCBSNC Blue Advantage 2026
via Gvoke Hypopen 2-Pack
Tier 3 - High Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Gvoke Hypopen 2-Pack
Tier 3 - High Cost Brand — — — None
BCBSNC Blue Local 2026
via Gvoke Hypopen 2-Pack
Tier 3 - High Cost Brand — — — None
BCBSNC Blue Care 2026
via Gvoke Hypopen 2-Pack
Tier 3 - High Cost Brand — — — None
BCBSNC Blue Advantage 2026 Tier 3 - High Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 3 - High Cost Brand — — — None
BCBSNC Blue Local 2026 Tier 3 - High Cost Brand — — — None
BCBSNC Blue Care 2026 Tier 3 - High Cost Brand — — — None
BCBSNC Blue Value 2026 Tier 3 - High Cost Brand — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 15 hours, 13 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Gvoke Hypopen 1-Pack
Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - HDHP 2026
via Gvoke Hypopen 2-Pack
Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Gvoke Hypopen 2-Pack
Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Gvoke Hypopen 2-Pack
Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Gvoke Hypopen 1-Pack
Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Gvoke Hypopen 1-Pack
Tier 2 - Non-Preferred Generic — — — None
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