alogliptin

6.25 MG — Tablet

Hypoglycemics - Oral — 2nd Generation Sulfonylureas

Also known as: Nesina

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 14 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold Tier 2 - Generic PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic PA | QL
Standard Expanded Bronze + Vision + Adult Dental Tier 2 - Generic PA | QL
Standard Silver + Vision + Adult Dental Tier 2 - Generic PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic PA | QL
Elite Bronze with Atrium Health Tier 2 - Generic PA | QL
Focused Silver with Atrium Health Tier 2 - Generic PA | QL
Complete Gold with Atrium Health Tier 2 - Generic PA | QL
Standard Expanded Bronze with Atrium Health Tier 2 - Generic PA | QL
Standard Silver with Atrium Health Tier 2 - Generic PA | QL
Standard Gold with Atrium Health Tier 2 - Generic PA | QL
Standard Gold + Vision + Adult Dental Tier 2 - Generic PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 2 - Generic PA | QL
Everyday Bronze Tier 2 - Generic PA | QL
Elite Bronze Tier 2 - Generic PA | QL
Clear Silver with $0 Insulin Options Tier 2 - Generic PA | QL
Standard Expanded Bronze Tier 2 - Generic PA | QL
Standard Silver Tier 2 - Generic PA | QL
Standard Gold Tier 2 - Generic PA | QL
Everyday Bronze with Atrium Health Tier 2 - Generic PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 2 - Generic PA | QL
Complete Gold + Vision + Adult Dental Tier 2 - Generic PA | QL
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic PA | QL
Elite Bronze + Vision + Adult Dental Tier 2 - Generic PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 14 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Nesina
Non-Preferred None
NC Medicaid Preferred Drug List 2026 Non-Preferred None
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