apomorphine hydrochloride

10 MG

Dopaminergic Agonist

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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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 13 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Silver 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
Everyday Bronze + 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 with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental 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
Clear Silver with $0 Insulin Options Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold 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
Source: CMS QHP JSON  ·  Checked: 13 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 5 - Specialty ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 13 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
HumanaChoice H5216-211 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Blue Medicare PPO Enhanced (PPO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Essential Plus (HMO-POS) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Enhanced (HMO-POS) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Choice (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Essential (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Experience Health Medicare Advantage (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health NC Duals (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health smartHMO (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum Select (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health AVA (PPO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Troy Medicare (HMO) Tier 5 - Specialty ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
Humana Gold Plus H1036-137 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H1036-233 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Dual Select H1036-307 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H1036-335 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice Giveback H5216-017 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Full Access H5525-034 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice Giveback H5525-035 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice H5525-049 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice H5525-050 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice H5525-070 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Dual Select H5525-072 (PPO D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
HumanaChoice H5525-083 (PPO) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H6622-025 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H6622-026 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H6622-057 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H6622-060 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus H6622-061 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Choice H8145-004 (PFFS) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 84 per 28 days PA | QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 13 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Onapgo 		Non-Preferred — — — None
Source: CMS QHP JSON  ·  Checked: 13 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Classic Standard | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Classic Standard | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic Tier 5 - Specialty ✓ — ✓ PA | QL
Secure Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic 4700 Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple PCP Saver Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Elite Saver Plus Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Diabetes Tier 5 - Specialty ✓ — ✓ PA | QL
Secure | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic 4700 | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Diabetes | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple PCP Saver | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic Standard | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Chronic Care CKM | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Diabetes | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Chronic Care CKM | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
AIAN Cost Share Tier 5 - Specialty ✓ — ✓ PA | QL
AIAN Cost Share | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Elite Saver Plus | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple PCP Saver | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Elite Saver Plus | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Chronic Care CKM | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Diabetes | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Chronic Care CKM | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
AIAN Cost Share
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
AIAN Cost Share | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Classic Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Classic Standard | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic Standard | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic Standard | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Classic Standard
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic Standard
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic Standard
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Secure
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic 4700
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple PCP Saver
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Elite Saver Plus
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Diabetes
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Secure | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic 4700 | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Diabetes | with Atrium Health
via Onapgo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 13 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Silver Standard (No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Bronze Standard (No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 5 - Specialty — — ✓ QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Gold Standard (No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 5 - Specialty — — ✓ QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 5 - Specialty — — ✓ QL
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