MIRABEGRON ER

25 MG, 50 MG, 8 MG/ML — SUSPENSION, EXTENDED RELEASE, RECON (ML)

beta3-Adrenergic Agonist

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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: PDF  ·  Formulary date: Oct 15, 2026  ·  Checked: 12 hours, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 5500 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect Silver 3000 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect Silver CMS Standard Tier 4 - Non-Preferred — — ✓ QL
Connect myDiabetesCare Silver Tier 4 - Non-Preferred — — ✓ QL
Connect Silver 3600 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect Bronze CMS Standard Tier 4 - Non-Preferred — — ✓ QL
Connect Gold CMS Standard Tier 4 - Non-Preferred — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect Bronze RD CMS Standard Tier 4 - Non-Preferred — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect Silver RD CMS Standard Tier 4 - Non-Preferred — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect Gold RD CMS Standard Tier 4 - Non-Preferred — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect Silver 5000 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect myDiabetesCare Bronze Tier 4 - Non-Preferred — — ✓ QL
Connect Gold 1500 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 12 hours, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Wellcare Giveback Open (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Simple (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Access (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Liberty Open (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Assist Open (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Simple Open (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Source: Excel (XLSX)  ·  Formulary date: Sep 23, 2026  ·  Checked: 12 hours, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Generic Formulary ✓ ✓ ✓ MYRBETRIQ SUSPENSION, ER, RECON (ML) LTD TO A MAX QTY OF 200 ML PER DISP AT RETAIL OR MAIL PA | ST | QL PA on 1 of 17 NDCs: TPA - MYRBETRIQ, MIRABEGRON ER SUSPENSION, EXTENDED RELEASE, RECON (ML) REQUIRES PRIOR AUTHORIZATION; Step therapy on 16 of 17 NDCs: GENERIC MIRABEGRON ER TABLET, EXTENDED RELEASE 24HR REQUIRES PRIOR AUTHORIZATION; Quantity limit on 1 of 17 NDCs
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