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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: 6 hours ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Elite Bronze + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Silver + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Gold + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze with Atrium Health
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Silver with Atrium Health
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Gold with Atrium Health
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Complete Gold Tier 4 - Non-Preferred — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze Tier 4 - Non-Preferred — — ✓ QL
Clear Silver with $0 Insulin Options Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze Tier 4 - Non-Preferred — — ✓ QL
Standard Silver Tier 4 - Non-Preferred — — ✓ QL
Standard Gold Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Focused Silver with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Complete Gold with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Standard Silver with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Standard Gold with Atrium Health Tier 4 - Non-Preferred — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Complete Gold + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze + Vision + Adult Dental Tier 4 - Non-Preferred — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Complete Gold + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Silver + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Gold + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Complete Gold
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Clear Silver with $0 Insulin Options
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Silver
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Standard Gold
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze with Atrium Health
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze with Atrium Health
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Focused Silver with Atrium Health
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Complete Gold with Atrium Health
via Ridaura 		Tier 4 - Non-Preferred — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 6 hours ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Alignment Health Platinum (HMO)
via Ridaura 		Tier 3 - Preferred Brand — — — None
Alignment Health NC Duals (HMO-POS D-SNP)
via Ridaura 		Tier 3 - Preferred Brand — — — None
Alignment Health smartHMO (HMO)
via Ridaura 		Tier 3 - Preferred Brand — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Ridaura 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum Select (HMO)
via Ridaura 		Tier 3 - Preferred Brand — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Ridaura 		Tier 3 - Preferred Brand — — — None
Alignment Health AVA (PPO)
via Ridaura 		Tier 3 - Preferred Brand — — — None
Blue Medicare Essential Plus (HMO-POS)
via Ridaura 		Tier 5 - Specialty — — — None
Blue Medicare Enhanced (HMO-POS)
via Ridaura 		Tier 5 - Specialty — — — None
Blue Medicare Choice (HMO)
via Ridaura 		Tier 5 - Specialty — — — None
Blue Medicare Essential (HMO)
via Ridaura 		Tier 5 - Specialty — — — None
Experience Health Medicare Advantage (HMO)
via Ridaura 		Tier 5 - Specialty — — — None
Healthy Blue + Medicare (HMO-POS D-SNP)
via Ridaura 		Tier 5 - Specialty — — — None
Blue Medicare PPO Enhanced (PPO)
via Ridaura 		Tier 5 - Specialty — — — None
HealthSpring TotalCare (HMO D-SNP)
via Ridaura 		Tier 5 - Specialty — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via Ridaura 		Tier 5 - Specialty — — — None
HealthSpring Preferred (HMO)
via Ridaura 		Tier 5 - Specialty — — — None
HealthSpring Preferred Select (HMO)
via Ridaura 		Tier 5 - Specialty — — — None
HealthSpring Preferred Savings (HMO)
via Ridaura 		Tier 5 - Specialty — — — None
HealthSpring Preferred Plus (HMO)
via Ridaura 		Tier 5 - Specialty — — — None
HealthSpring True Choice (PPO)
via Ridaura 		Tier 5 - Specialty — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 6 hours ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026
via Ridaura 		Tier 5 - Specialty — — — None
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