OMNIPOD DASH INTRO

Kit

Also known as: OMNIPOD DASH INTRO KIT (G- insulin infusion disposable pump kit Omnipod Dash Intro Kit (Gen 4)

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 7 hours, 38 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
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

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 7 hours, 38 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 2 - Preferred Brand	—	—	✓	QL