adalimumab-adbm

Generic: Cyltezo Psoriasis-UV

10 mg/0.2 mL, 20 mg/0.4 mL, 40 mg/0.4 mL, 40 mg/0.8 mL — Prefilled Syringe

Also known as: ADALIMUMAB-ADBM(CF)PEN ADALIMUMAB-ADBM(CF) ADALIMUMAB-ADBM(CF) PEN CROHNS CYLTEZO(CF) PEN CYLTEZO(CF) PEN PSORIASIS-UV CYLTEZO(CF) CYLTEZO(CF) PEN CROHN'S-UC-HS ADALIMUMAB-ADBM(CF) PEN ADALIMUMAB-ADBM(CF) PEN PS-UV adalimumab-adbm Pen Manufacturer: Quallent

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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.

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 19 hours, 10 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Everyday Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL

Cigna

40 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 19 hours, 10 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Silver 4400 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze CMS Standard via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold RD CMS Standard via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD CMS Standard via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold CMS Standard via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD CMS Standard via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver CMS Standard via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 6500 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 3000 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 5000 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze CMS Standard via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold RD CMS Standard via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD CMS Standard via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold CMS Standard via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD CMS Standard via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD 6000 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 3500 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD 5000 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 3500 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 7000 HSA Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver CMS Standard via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect myDiabetesCare Silver via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 2200 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold 1500 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect myDiabetesCare Bronze via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 5500 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD 6000 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 3500 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD 5000 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 3500 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 7000 HSA Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 4400 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 5000 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 3000 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 6500 Indiv Med Deductible via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect myDiabetesCare Silver via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 2200 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold 1500 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect myDiabetesCare Bronze via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 5500 Indiv Med Deductible via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓	PA \| QL

Medicare Part D

144 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 19 hours, 10 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Provider Partners North Carolina Advantage Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 6 per 28 days	PA \| QL
Provider Partners North Carolina Community Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 6 per 28 days	PA \| QL
Provider Partners North Carolina Essential Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 6 per 28 days	PA \| QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP) via ADALIMUMAB-ADBM(CF)	Tier 1 - Preferred Generic	✓	—	✓ 2 per 28 days	PA \| QL
Provider Partners North Carolina Community Plan (HMO I-SNP) via ADALIMUMAB-ADBM(CF)	Tier 1 - Preferred Generic	✓	—	✓ 2 per 28 days	PA \| QL
Provider Partners North Carolina Essential Plan (HMO I-SNP) via ADALIMUMAB-ADBM(CF)	Tier 1 - Preferred Generic	✓	—	✓ 2 per 28 days	PA \| QL
HealthTeam Advantage Plan II (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HealthTeam Advantage Vitality Plan (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Wellcare Dual Liberty Open (PPO D-SNP) via Cyltezo	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Wellcare Assist Open (PPO) via Cyltezo	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Wellcare Dual Access (HMO-POS D-SNP) via Cyltezo	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Wellcare Dual Liberty (HMO-POS D-SNP) via Cyltezo	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Wellcare Dual Liberty Open (PPO D-SNP) via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Wellcare Assist Open (PPO) via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Wellcare Dual Access (HMO-POS D-SNP) via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Wellcare Dual Liberty (HMO-POS D-SNP) via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Wellcare Dual Reserve (HMO-POS D-SNP) via Cyltezo	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Wellcare Dual Reserve (HMO-POS D-SNP) via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
UHC Dual Complete NC-S001 (PPO D-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
UHC Dual Complete NC-S2 (PPO D-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0001 (PPO)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0004 (PPO)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0016 (PPO)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0017 (PPO)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0019 (PPO)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Erickson Advantage Signature (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Erickson Advantage Guardian (HMO-POS I-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Erickson Advantage Freedom (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Erickson Advantage Liberty (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
UHC Dual Complete NC-S001 (PPO D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
UHC Dual Complete NC-S2 (PPO D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0001 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0004 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0016 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0017 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0019 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Erickson Advantage Signature (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Erickson Advantage Guardian (HMO-POS I-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Erickson Advantage Freedom (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Erickson Advantage Liberty (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
UHC Complete Care NC-25 (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
UHC Complete Care NC-27 (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
UHC Complete Care NC-28 (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Erickson Advantage Champion (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
UHC Complete Care NC-25 (HMO-POS C-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
UHC Complete Care NC-27 (HMO-POS C-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
UHC Complete Care NC-28 (HMO-POS C-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Erickson Advantage Champion (HMO-POS C-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Wellcare Simple Open (PPO) via Cyltezo	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Wellcare Simple (HMO-POS) via Cyltezo	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Wellcare Simple Open (PPO) via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Wellcare Simple (HMO-POS) via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Wellcare Giveback Open (PPO) via Cyltezo	Tier 5 - Specialty	✓	—	✓ 4 per 28 days	PA \| QL
Wellcare Giveback Open (PPO) via CYLTEZO(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HealthTeam Advantage Plan I (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HealthTeam Advantage Plan II (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HealthTeam Advantage Vitality Plan (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HealthTeam Advantage Plan I (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Full Access H5525-034 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HumanaChoice Giveback H5525-035 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HumanaChoice H5525-049 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HumanaChoice H5525-050 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HumanaChoice H5525-070 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Dual Select H5525-072 (PPO D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HumanaChoice H5525-083 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus H6622-025 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus H6622-026 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus H6622-057 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus H6622-060 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus H6622-061 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Choice H8145-004 (PFFS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus H1036-137 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus H1036-233 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Dual Select H1036-307 (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus Giveback H1036-318 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus H1036-335 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HumanaChoice Giveback H5216-017 (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HumanaChoice H5216-211 (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Full Access H5525-034 (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HumanaChoice Giveback H5525-035 (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HumanaChoice H5525-049 (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HumanaChoice H5525-050 (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HumanaChoice H5525-070 (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Dual Select H5525-072 (PPO D-SNP)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
HumanaChoice H5525-083 (PPO)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus H6622-025 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus H6622-026 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Dual Select H6622-027 (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus H6622-057 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus H6622-060 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus H6622-061 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Choice H8145-004 (PFFS)	Tier 5 - Specialty	✓	—	✓ 6 per 28 days	PA \| QL
Humana Gold Plus H1036-137 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus H1036-233 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Dual Select H1036-307 (HMO D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
Humana Gold Plus H1036-335 (HMO-POS) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HumanaChoice Giveback H5216-017 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL
HumanaChoice H5216-211 (PPO) via ADALIMUMAB-ADBM(CF)	Tier 5 - Specialty	✓	—	✓ 2 per 28 days	PA \| QL

NC Medicaid PDL

2 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 19 hours, 10 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Non-Preferred	✓	✓	—	PA \| ST
NC Medicaid Preferred Drug List 2026 via Cyltezo Psoriasis-UV	Non-Preferred	✓	✓	—	PA \| ST

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jun 24, 2026 · Checked: 19 hours, 10 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA

UnitedHealthcare

13 plans

Source: PDF · Formulary date: Jun 23, 2026 · Checked: 19 hours, 10 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Bronze Standard (No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals	Tier 5 - Specialty	✓	—	—	PA
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Bronze Standard+ Dental + Vision (No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Gold Standard (No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Silver Standard (No Referrals)	Tier 5 - Specialty	✓	—	—	PA
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)	Tier 5 - Specialty	✓	—	—	PA