insulin glargine/lixisenatide

100-33/ML — Pen Injector

DIABETES NON-INSULIN

Also known as: SOLIQUA 100-33
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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: Excel (XLSX)  ·  Formulary date: Oct 29, 2026  ·  Checked: 5 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via Soliqua 100-33 		Tier 3 - Non-Formulary ✓ — — PA PA: PA DRUGS, DOD PA REQUIRED
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