Omnipod 5 Dexcom G7G6 Pod

Generic: insulin infusion disposable pump reservoir

ANTIDOTES

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: Apr 1, 2026  ·  Checked: 16 hours, 7 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via Twiist Refill
Tier 3 - High Cost Brand PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026
via Twiist Refill
Tier 3 - High Cost Brand PA | QL
BCBSNC Blue Local 2026
via Twiist Refill
Tier 3 - High Cost Brand PA | QL
BCBSNC Blue Care 2026
via Twiist Refill
Tier 3 - High Cost Brand PA | QL
BCBSNC Blue Value 2026
via Twiist Refill
Tier 3 - High Cost Brand PA | QL
BCBSNC Blue Advantage 2026 Tier 4 - Higher Cost Brand PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 4 - Higher Cost Brand PA | QL
BCBSNC Blue Local 2026 Tier 4 - Higher Cost Brand PA | QL
BCBSNC Blue Care 2026 Tier 4 - Higher Cost Brand PA | QL
BCBSNC Blue Value 2026 Tier 4 - Higher Cost Brand PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 7 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Twiist Refill
Tier 2 - Non-Preferred Generic None
NC State Health Plan - 70/30 Standard PPO 2026
via Twiist Refill
Tier 2 - Non-Preferred Generic None
NC State Health Plan - HDHP 2026
via Twiist Refill
Tier 2 - Non-Preferred Generic None
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