Victoza

Generic: liraglutide

18 MG — Pen Injector

Hypoglycemics - Injectable — Rapid Acting Insulin

Coverage by Insurer

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

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 19 hours, 1 minute ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Standard Gold with Atrium Health + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze with Atrium Health via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Silver with Atrium Health via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Gold with Atrium Health via liraglutide	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Complete Gold + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Silver + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Gold + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Silver with Atrium Health + Vision + Adult Dental via liraglutide	Tier 2 - Generic	—	—	✓	QL
Complete Gold via liraglutide	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via liraglutide	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze via liraglutide	Tier 2 - Generic	—	—	✓	QL
Elite Bronze via liraglutide	Tier 2 - Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Silver via liraglutide	Tier 2 - Generic	—	—	✓	QL
Standard Gold via liraglutide	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health via liraglutide	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health via liraglutide	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health via liraglutide	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health via liraglutide	Tier 2 - Generic	—	—	✓	QL

Medicare Part D

12 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 19 hours, 1 minute ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
PruittHealth Premier (HMO I-SNP) via liraglutide	Tier 1 - Preferred Generic	✓	—	✓ 9 per 30 days	PA \| QL
Liberty Medicare Dual Plan (HMO D-SNP) via liraglutide	Tier 1 - Preferred Generic	✓	—	✓ 9 per 30 days	PA \| QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) via liraglutide	Tier 1 - Preferred Generic	✓	—	✓ 9 per 30 days	PA \| QL
Longevity Health Plan (HMO I-SNP) via liraglutide	Tier 1 - Preferred Generic	✓	—	✓ 9 per 30 days	PA \| QL
NHC Advantage (HMO I-SNP) via liraglutide	Tier 1 - Preferred Generic	✓	—	✓ 9 per 30 days	PA \| QL
Senior Care (HMO I-SNP) via liraglutide	Tier 2 - Generic	✓	—	✓ 9 per 30 days	PA \| QL
Liberty Medicare Advantage (HMO C-SNP) via liraglutide	Tier 2 - Generic	✓	—	✓ 9 per 30 days	PA \| QL
Troy Medicare (HMO) via liraglutide	Tier 2 - Generic	✓	—	✓ 9 per 30 days	PA \| QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via liraglutide	Tier 2 - Generic	✓	—	✓ 9 per 30 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP) via liraglutide	Tier 2 - Generic	✓	—	✓ 9 per 30 days	PA \| QL
Wellcare Dual Reserve (HMO-POS D-SNP) via liraglutide	Tier 3 - Preferred Brand	✓	—	✓ 9 per 30 days	PA \| QL
Wellcare Giveback Open (PPO) via liraglutide	Tier 3 - Preferred Brand	✓	—	✓ 9 per 30 days	PA \| QL

NC Medicaid PDL

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 19 hours, 1 minute ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Preferred	✓	✓	—	PA \| ST
NC Medicaid Preferred Drug List 2026 via Saxenda Saxenda is the same molecule (liraglutide) but is indicated for weight management, while Victoza is for type 2 diabetes. Coverage may differ by indication.	Non-Preferred	✓	—	—	PA
NC Medicaid Preferred Drug List 2026 via liraglutide	Non-Preferred	✓	✓	—	PA \| ST

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 19 hours, 1 minute ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via liraglutide	Tier 3 - Non-Formulary	✓	—	✓	PA \| QL