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insulin degludec and liraglutide 100 [iU]/mL / 3.6 mg/mL Medicare Part D Coverage

Brand name: Xultophy 100/3.6
Dosage form
INJECTION, SOLUTION
Route
SUBCUTANEOUS
34%
of Medicare Part D plans
cover insulin degludec and liraglutide
1,878 of 5,530 plans
3.0
Avg. formulary tier
$0.00
Median 30-day copay
$0.00–$0.00
Copay range

Formulary Tier Distribution

How Medicare Part D plans classify insulin degludec and liraglutide. Lower tiers = lower copays.

Tier 1 - Preferred Generic 3%
57 plans • avg $0.00/mo
Tier 2 - Generic 0%
6 plans • avg $7.50/mo
Tier 3 - Preferred Brand 96%
1,795 plans • avg $8.97/mo
Tier 5 - Specialty 0%
2 plans • avg $0.00/mo
Tier 6 - Select Care 1%
18 plans • avg $0.00/mo

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insulin degludec and liraglutide Medicare Coverage by State

Coverage rates and average costs vary significantly by state. Click a state to see the specific plans available there.

Alternative Medications in the Same Drug Class

Other drugs in the Diabetes — Insulin that Medicare Part D plans also cover.

Frequently Asked Questions about insulin degludec and liraglutide

34% of Medicare Part D plans cover insulin degludec and liraglutide. It is most commonly placed on Tier 3. Coverage varies by plan and geographic area.

The median 30-day copay for insulin degludec and liraglutide on Medicare Part D is $0.00 at a preferred pharmacy. Costs range from $0.00 to $0.00 depending on the plan.

insulin degludec and liraglutide is placed on Tier 3 by most Medicare Part D plans. Lower tier numbers generally mean lower copays.

0% of plans require prior authorization for insulin degludec and liraglutide. Prior authorization means your doctor must confirm the drug is medically necessary before the plan will cover it.

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Coverage statistics based on CMS formulary data for plan year 2026. Data updated regularly. Methodology →