azathioprine
Generic: Azasan
50mg, 75mg, 100mg — Tablet
Also known as:
azathioprine oral tablet 50 mg
Imuran
azathioprine tabs 50mg
azathioprine tabs 75mg
azathioprine tabs 100mg
azathioprine tab 50 mg
azathioprine tab 75 mg, 100 mg
Azathioprine 50 Mg Tablet
azathioprine tabs 50mg, 75mg, 100mg
Compare Prices
Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Ambetter (Centene)
58 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold
via Azasan |
Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Gold | Tier 2 - Generic | — | — | — | None |
| Elite Bronze | Tier 2 - Generic | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | — | None |
| Complete Gold | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
8 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Azasan |
Tier 1 - Generic | — | — | — | None |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Azasan |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Focus 2026
via Azasan |
Tier 1 - Generic | — | — | — | None |
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Imuran |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Imuran |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Blue Cross Blue Shield of NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Value 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Care 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Imuran |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Imuran |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Local 2026
via Imuran |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Care 2026
via Imuran |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Value 2026
via Imuran |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Advantage 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Local 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
Cigna
1 planMedicare Part D
140 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| HumanaChoice H5216-211 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Full Access H5525-034 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| HumanaChoice H5525-049 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| HumanaChoice H5525-050 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| HumanaChoice H5525-070 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| HumanaChoice H5525-083 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Choice H8145-004 (PFFS) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Senior Care (HMO I-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Erickson Advantage Signature (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Erickson Advantage Freedom (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Erickson Advantage Liberty (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Dual (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Value Plus (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Prime (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Signature Care (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Enhanced (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Signature Extra (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Signature Giveback (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Simple Open (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Simple (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Giveback Open (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Blue Medicare PPO Enhanced (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Blue Medicare Essential Plus (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Blue Medicare Enhanced (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Blue Medicare Choice (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Blue Medicare Essential (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Experience Health Medicare Advantage (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Alignment Health Platinum (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Alignment Health smartHMO (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Alignment Health Platinum Select (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Alignment Health AVA (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| HealthTeam Advantage Plan I (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| HealthTeam Advantage Plan II (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Troy Medicare (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Assist Open (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus H1036-137 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED CHOICE 008 NC (PPO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED CHOICE 005 NC (PPO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED CHOICE 003 NC (PPO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED CHOICE 001 NC (PPO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED CORE 001 NC (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| HealthSpring True Choice (PPO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| HealthSpring TotalCare (HMO D-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| HealthSpring Preferred (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| HealthSpring Preferred Select (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| HealthSpring Preferred Savings (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| HealthSpring Preferred Plus (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
NC Medicaid PDL
2 plansNC State Health Plan
9 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 70/30 Standard PPO 2026
via Azasan |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Azasan |
Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Azasan |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Imuran |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Imuran |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Imuran |
Tier 3 - Non-Preferred Brand | — | — | — | None |