Levemir Flexpen

Generic: insulin detemir

100/ML (3) — Pen Injector

INSULINS

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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: Sep 22, 2026  ·  Checked: 5 hours, 28 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Levemir 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Levemir 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Levemir 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Levemir 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Levemir 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Levemir 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Silver Premier + No Referrals
via Levemir 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Levemir 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Levemir 		Tier 4 - Non-Preferred — ✓ — ST
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 5 hours, 28 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026
via Levemir 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Levemir 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Levemir 		Not Covered — — — None
Source: CMS QHP JSON  ·  Formulary date: Oct 13, 2026  ·  Checked: 5 hours, 28 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
69803NC0010083
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010084
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010085
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Simple Diabetes
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Core Plan
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Core Plan | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Simple Diabetes with Adult Dental & Vision
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010108
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010109
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010110
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010111
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010112
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010113
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010114
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010115
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010116
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010117
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Elite + PCP Saver Plus
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Classic
via Levemir 		Tier 3 - Preferred Brand — — — None
Secure
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Classic 4700
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Simple PCP Saver
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Simple Diabetes
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Classic Standard
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Classic Standard
via Levemir 		Tier 3 - Preferred Brand — — — None
Gold Classic Standard
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Classic Standard | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Classic Standard | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Gold Classic Standard | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Secure | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Classic 4700 | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Classic | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Simple Diabetes | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Simple PCP Saver | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Simple Diabetes | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010074
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010075
via Levemir 		Tier 3 - Preferred Brand — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010076
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010077
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010078
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010079
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010080
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010081
via Levemir 		Tier 3 - Preferred Brand — — — None
69803NC0010082
via Levemir 		Tier 3 - Preferred Brand — — — None
Source: Excel (XLSX)  ·  Formulary date: Sep 23, 2026  ·  Checked: 5 hours, 28 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via Levemir 		Tier 3 - Non-Formulary ✓ — — PA PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary ✓ — — PA PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 5 hours, 28 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via Levemir 		Tier 0 - $0 Preventive — — ✓ QL
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