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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: Jan 1, 2026  ·  Checked: 5 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 6500 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze 5500 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Silver 4400 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Silver 3500 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Silver 3000 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze CMS Standard Tier 3 - Preferred Brand ✓ — — PA
Connect Silver CMS Standard Tier 3 - Preferred Brand ✓ — — PA
Connect Gold CMS Standard Tier 3 - Preferred Brand ✓ — — PA
Connect myDiabetesCare Bronze Tier 3 - Preferred Brand ✓ — — PA
Connect myDiabetesCare Silver Tier 3 - Preferred Brand ✓ — — PA
Connect Gold 1500 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze RD 5000 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze RD 6000 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze RD CMS Standard Tier 3 - Preferred Brand ✓ — — PA
Connect Silver RD 3500 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Silver RD 5000 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Silver RD CMS Standard Tier 3 - Preferred Brand ✓ — — PA
Connect Silver RD 2200 Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Connect Gold RD CMS Standard Tier 3 - Preferred Brand ✓ — — PA
Connect Bronze 7000 HSA Indiv Med Deductible Tier 3 - Preferred Brand ✓ — — PA
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 5 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Gold Standard (No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 4 - Non-Preferred — — ✓ QL
UHC Silver Standard (No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Bronze Standard (No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — ✓ QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — ✓ QL
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