Ultima

Generic: blood sugar diagnostic

Test Strip

Also known as: ULTIMA TES
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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: 11 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver RD 3500 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Silver 4400 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 5000 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Silver 3000 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Bronze 6500 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect myDiabetesCare Silver
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 2200 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Gold 1500 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect myDiabetesCare Bronze
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Bronze 5500 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Silver 3500 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 3500 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Silver 4400 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 5000 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Silver 3000 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Bronze 6500 Indiv Med Deductible
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Silver CMS Standard
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Silver RD CMS Standard
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Gold CMS Standard
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD CMS Standard
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Gold RD CMS Standard
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Bronze CMS Standard
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Silver CMS Standard
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Silver RD CMS Standard
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Gold CMS Standard
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD CMS Standard
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Gold RD CMS Standard
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Bronze CMS Standard
via INFINITY TEST STRIPS 		Tier 3 - Preferred Brand — — — None
Connect Silver CMS Standard
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Silver RD CMS Standard
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Gold CMS Standard
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD CMS Standard
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Gold RD CMS Standard
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Bronze CMS Standard
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect myDiabetesCare Silver
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 2200 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Gold 1500 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect myDiabetesCare Bronze
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Bronze 5500 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Silver 3500 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 3500 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Silver 4400 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 5000 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Silver 3000 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Bronze 6500 Indiv Med Deductible
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Silver CMS Standard
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Silver RD CMS Standard
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Gold CMS Standard
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD CMS Standard
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Gold RD CMS Standard
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect myDiabetesCare Silver
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 2200 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Gold 1500 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect myDiabetesCare Bronze
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Bronze 5500 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Silver 3500 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 3500 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Silver 4400 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 5000 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Bronze CMS Standard
via True Metrix Glucose Test Strip 		Tier 3 - Preferred Brand — — — None
Connect Silver 3000 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect Bronze 6500 Indiv Med Deductible
via Embrace 		Tier 3 - Preferred Brand — — — None
Connect myDiabetesCare Silver
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 2200 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Gold 1500 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect myDiabetesCare Bronze
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Bronze 5500 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Silver 3500 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via Easymax 		Tier 3 - Preferred Brand — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 11 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026
via Fora V12 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Caresens N 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Caresens N 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Caresens N 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Diatrue Plus 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Diatrue Plus 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Diatrue Plus 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Easy Plus Ii 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Easy Plus Ii 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Easy Plus Ii 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Easy Step 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Easy Step 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Easy Step 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Easy Talk 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Easy Talk 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Easy Talk 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Easy Trak 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Easy Trak 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Easy Trak 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Easymax 15 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Easymax 15 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Easymax 15 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Easymax 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Easymax 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Easymax 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Embrace 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Embrace 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Embrace 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Fora D15G 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Fora D15G 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Fora D15G 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Fora D20 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Fora D20 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Fora D20 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Fora G20 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Fora G20 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Fora G20 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Fora V10 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Fora V10 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Fora V10 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Fora V12 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Fora V12 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Fora V20 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Fora V20 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Fora V20 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Fora V30A 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Fora V30A 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Fora V30A 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Microdot 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Microdot 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Microdot 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Quintet Ac 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Quintet Ac 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Quintet Ac 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Unistrip1 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Unistrip1 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Unistrip1 		Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: Jun 24, 2026  ·  Checked: 11 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via blood sugar diagnostic 		Tier 1 - Basic Core Formulary ✓ — ✓ PA | QL
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