3 ML liraglutide 6 MG/ML Pen Injector [Victoza]
liraglutide
RxCUI: 897126
What the CMS Formulary Data Shows for 3 ML liraglutide 6 MG/ML Pen Injector [Victoza]
Per the CMS 2026 Part D formulary file, 3 ML liraglutide 6 MG/ML Pen Injector [Victoza] (RxNorm concept RXCUI 897126, generic name liraglutide) appears on 2 distinct formulary files spanning 6 Medicare Part D plan offerings - 0.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 3 to Tier 4, with a cross-plan average of Tier 3.5.
Real-world access to 3 ML liraglutide 6 MG/ML Pen Injector [Victoza] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 50% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 3 ML liraglutide 6 MG/ML Pen Injector [Victoza] today.
Coverage Details
- Formularies covering
- 2
- Plans covering
- 6
- Coverage rate
- 0.1%
- Tier range
- Tier 3 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 50% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 3 ML liraglutide 6 MG/ML Pen Injector [Victoza]
6 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Health New England Medicare Compass (PPO) | HEALTH NEW ENGLAND, INC. | T3 | Yes | $0 | MA |
| Health New England Medicare Value (HMO) | HEALTH NEW ENGLAND, INC. | T3 | Yes | $0 | MA |
| Health New England Medicare Premium (HMO) | HEALTH NEW ENGLAND, INC. | T3 | Yes | $15.80 | MA |
| Health New England Medicare Plus (HMO) | HEALTH NEW ENGLAND, INC. | T3 | Yes | $58.40 | MA |
| FHCP Medicare Classic (HMO) | FLORIDA BLUE MEDICARE, INC. | T4 | Yes | $0 | FL |
| FHCP Medicare Rx Plus (HMO-POS) | FLORIDA BLUE MEDICARE, INC. | T4 | Yes | $49.00 | FL |
Frequently Asked Questions
Is 3 ML liraglutide 6 MG/ML Pen Injector [Victoza] covered by Medicare Part D?
Yes, 3 ML liraglutide 6 MG/ML Pen Injector [Victoza] is covered by 6 Medicare Part D plans (0.1% of all Part D formularies).
What tier is 3 ML liraglutide 6 MG/ML Pen Injector [Victoza] on Medicare Part D plans?
3 ML liraglutide 6 MG/ML Pen Injector [Victoza] averages Tier 3.5 across Part D plans, ranging from Tier 3 to Tier 4.
Does 3 ML liraglutide 6 MG/ML Pen Injector [Victoza] require prior authorization?
100% of Part D formularies require prior authorization for 3 ML liraglutide 6 MG/ML Pen Injector [Victoza]. Step therapy: 0%. Quantity limits: 50%.
Read our methodology - how this data is sourced, computed, and verified.