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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: 4 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 5000 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 5000 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3600 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 5000 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3600 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3600 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 5000 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3600 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Pocket Chamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Aerochamber Plus Flow-Vu 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze CMS Standard
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD CMS Standard
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD CMS Standard
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver CMS Standard
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold RD CMS Standard
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold CMS Standard
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Gold 1500 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 5000 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3600 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 5000 Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3600 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 5000 Indiv Med Deductible
via AEROCHAMBER2GO 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Aerochamber Mini 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Microchamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Silver
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3600 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3000 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 5000 Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible
via Ace 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect myDiabetesCare Bronze
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible
via Flexichamber 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver 3600 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible
via Easivent 		Tier 3 - Preferred Brand — — ✓ QL
Source: Excel (XLSX)  ·  Formulary date: Sep 23, 2026  ·  Checked: 4 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via Ace 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Aerochamber Mechanical Vent 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Aerochamber Mini 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Aerochamber Mv 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Aerochamber Plus Flow-Vu 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via AEROCHAMBER2GO 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Aerotrach Plus 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Aerovent Plus 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Breatherite 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Breathrite 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Compact Space Chamber 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Easivent 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Flexichamber 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Liteaire 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Microchamber 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Microspacer 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Optichamber Diamond 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Pocket Chamber 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Primeaire 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026 Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Riteflo 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Space Chamber 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Vortex 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Spacer 		Tier 2 - Brand Formulary (Basic Core) — — — None
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