Amniocore

Miscellaneous

1%; lotn .75%

Also known as: AMNIOCORE MIS 2CMX3CM AMNIOCORE MIS 2X12CM AMNIOCORE MIS 3CMX3CM AMNIOCORE MIS 3CMX4CM AMNIOCORE MIS 4CMX4CM AMNIOCORE MIS 4CMX6CM AMNIOCORE MIS 4CMX8CM AMNIOCORE MIS 6CMX9CM AMNIOCORE MIS 6X16CM AMNIOCORE MIS 9X20CM

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 13 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Medical Benefit None
NC State Health Plan - 70/30 Standard PPO 2026 Medical Benefit None
NC State Health Plan - HDHP 2026 Medical Benefit None
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