Apretude

Generic: cabotegravir

600MG/3ML — Vial

FLUOROQUINOLONES

Also known as: APRETUDE SUER 600MG/3ML Apretude Er 600 Mg/3 Ml Vial cabotegravir
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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: 10 hours, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Complete Gold
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Everyday Bronze
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Elite Bronze
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Clear Silver with $0 Insulin Options
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Expanded Bronze
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Silver
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Gold
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Everyday Bronze with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Elite Bronze with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Focused Silver with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Complete Gold with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Expanded Bronze with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Silver with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Gold with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Gold with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Complete Gold + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Everyday Bronze + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Elite Bronze + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Expanded Bronze + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Gold with Atrium Health + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Complete Gold + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Everyday Bronze + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Elite Bronze + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Expanded Bronze + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Silver + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Gold + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Silver with Atrium Health + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Standard Gold with Atrium Health + Vision + Adult Dental
via CABENUVA 400 MG / 600 MG 		Tier 4 - Non-Preferred — — — None
Complete Gold with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Expanded Bronze with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Silver with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Silver + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Gold + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Silver with Atrium Health + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Everyday Bronze
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Elite Bronze
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Clear Silver with $0 Insulin Options
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Expanded Bronze
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Silver
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Standard Gold
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Everyday Bronze with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Complete Gold
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Elite Bronze with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Focused Silver with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 4 - Non-Preferred — — — None
Source: CMS QHP JSON  ·  Checked: 10 hours, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 3 - Preferred Brand — — ✓ QL
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 3 - Preferred Brand — — ✓ QL
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 3 - Preferred Brand — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 3 - Preferred Brand — — ✓ QL
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 3 - Preferred Brand — — ✓ QL
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 3 - Preferred Brand — — ✓ QL
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 3 - Preferred Brand — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 3 - Preferred Brand — — ✓ QL
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 3 - Preferred Brand — — ✓ QL
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 3 - Preferred Brand — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via CABENUVA 400 MG / 600 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Vocabria 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Vocabria 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Essential + No Referrals
via Vocabria 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Vocabria 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Vocabria 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Signature + No Referrals
via Vocabria 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Premier + No Referrals
via Vocabria 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Signature + No Referrals
via Vocabria 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Premier + No Referrals
via Vocabria 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Vocabria 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Essential + No Referrals
via CABENUVA 600 MG / 900 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Signature + No Referrals
via CABENUVA 600 MG / 900 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Premier + No Referrals
via CABENUVA 600 MG / 900 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Premier + No Referrals
via CABENUVA 600 MG / 900 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Premier + No Referrals
via CABENUVA 600 MG / 900 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via CABENUVA 600 MG / 900 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Signature + No Referrals
via CABENUVA 600 MG / 900 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Signature + No Referrals
via CABENUVA 600 MG / 900 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via CABENUVA 600 MG / 900 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Essential + No Referrals
via CABENUVA 600 MG / 900 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Premier + No Referrals
via CABENUVA 400 MG / 600 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Premier + No Referrals
via CABENUVA 400 MG / 600 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Essential + No Referrals
via CABENUVA 400 MG / 600 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Signature + No Referrals
via CABENUVA 400 MG / 600 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Signature + No Referrals
via CABENUVA 400 MG / 600 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Signature + No Referrals
via CABENUVA 400 MG / 600 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via CABENUVA 400 MG / 600 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Essential + No Referrals
via CABENUVA 400 MG / 600 MG 		Brand-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Premier + No Referrals
via CABENUVA 400 MG / 600 MG 		Brand-Preferred — — ✓ QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 10 hours, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 2 - Preferred Brand ✓ — — NCTM for HIV PrEP PA
BCBS Federal Standard Option 2026 Tier 2 - Preferred Brand ✓ — — NCTM for HIV PrEP PA
BCBS Federal Focus 2026 Tier 2 - Preferred Brand ✓ — — NCTM for HIV PrEP PA
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 10 hours, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Care 2026 Tier A - ACA $0 Copay — — — Limited Distribution None
BCBSNC Blue Local 2026 Tier A - ACA $0 Copay — — — Limited Distribution None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier A - ACA $0 Copay — — — Limited Distribution None
BCBSNC Blue Advantage 2026 Tier A - ACA $0 Copay — — — Limited Distribution None
BCBSNC Blue Value 2026 Tier A - ACA $0 Copay — — — Limited Distribution None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 10 hours, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026 Tier 0 - $0 Copay (ACA Preventive) — — ✓ QL
NC State Health Plan - 80/20 Plus PPO 2026 Tier 0 - $0 Copay (ACA Preventive) — — ✓ QL
NC State Health Plan - HDHP 2026 Tier 0 - $0 Copay (ACA Preventive) — — ✓ QL
Source: CMS QHP JSON  ·  Checked: 10 hours, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Classic Standard Tier 0 - $0 Preventive — — ✓ QL
Gold Classic Standard Tier 0 - $0 Preventive — — ✓ QL
Bronze Classic Standard | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Silver Classic Standard | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Gold Classic Standard | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Bronze Elite + PCP Saver Plus Tier 0 - $0 Preventive — — ✓ QL
Silver Classic Tier 0 - $0 Preventive — — ✓ QL
Secure Tier 0 - $0 Preventive — — ✓ QL
Bronze Classic 4700 Tier 0 - $0 Preventive — — ✓ QL
Silver Simple PCP Saver Tier 0 - $0 Preventive — — ✓ QL
Gold Elite Saver Plus Tier 0 - $0 Preventive — — ✓ QL
Silver Simple Diabetes Tier 0 - $0 Preventive — — ✓ QL
Secure | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Bronze Classic 4700 | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Silver Classic | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Silver Simple Diabetes | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Silver Simple PCP Saver | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Gold Elite Saver Plus | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Bronze Simple Chronic Care CKM | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Bronze Simple Diabetes | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Silver Simple Chronic Care CKM | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
AIAN Cost Share Tier 0 - $0 Preventive — — ✓ QL
AIAN Cost Share | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Bronze Classic Standard Tier 0 - $0 Preventive — — ✓ QL
Silver Simple Diabetes
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Secure | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic 4700 | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Elite + PCP Saver Plus | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Diabetes | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple PCP Saver | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Gold Elite Saver Plus | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Chronic Care CKM | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Diabetes | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Chronic Care CKM | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
AIAN Cost Share
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
AIAN Cost Share | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic Standard
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic Standard
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Gold Classic Standard
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic Standard | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic Standard | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Gold Classic Standard | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Elite + PCP Saver Plus
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Secure
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic 4700
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple PCP Saver
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Gold Elite Saver Plus
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Diabetes
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Secure | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic 4700 | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Elite + PCP Saver Plus | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Diabetes | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple PCP Saver | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Gold Elite Saver Plus | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Chronic Care CKM | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Diabetes | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Chronic Care CKM | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
AIAN Cost Share
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
AIAN Cost Share | with Atrium Health
via CABENUVA 400 MG / 600 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic Standard
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic Standard
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Gold Classic Standard
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic Standard | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic Standard | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Gold Classic Standard | with Atrium Health
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Elite + PCP Saver Plus
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Secure
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic 4700
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple PCP Saver
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
Gold Elite Saver Plus
via CABENUVA 600 MG / 900 MG 		Tier 3 - Preferred Brand — — ✓ QL
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