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
azaTHIOprine Oral Tablet
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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.
Ambetter (Centene)
58 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Standard Expanded Bronze with Atrium Health
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health
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 |
|
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 |
|
Everyday Bronze
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
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 |
|
Complete Gold
via Azasan |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Azasan |
Tier 2 - Generic | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | — | None |
| Standard Silver | Tier 2 - Generic | — | — | — | None |
| Standard Gold | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Elite Bronze | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health | 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 |
| Focused Silver with Atrium Health + Vision + Adult Dental | 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 |
| Complete Gold | 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 Expanded Bronze with Atrium Health + Vision + Adult Dental
via Azasan |
Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health + Vision + Adult Dental | 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 |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | 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 Basic Option 2026 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Focus 2026
via Azasan |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Azasan |
Tier 1 - Generic | — | — | — | None |
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Azasan |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Imuran |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard 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 Local 2026
via Imuran |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Advantage 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 |
| BCBSNC Blue Care 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Value 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Value 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 Home with UNC Health Alliance 2026
via Imuran |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Gold RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Gold 1500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect myDiabetesCare Silver | Tier 2 - Generic | — | — | — | None |
| Connect myDiabetesCare Bronze | Tier 2 - Generic | — | — | — | None |
| Connect Gold CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver 3000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver 3500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver 4400 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 5500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 6500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
Medicare 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 |
| Provider Partners North Carolina Advantage Plan (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 |
| Liberty Medicare Dual Plan (HMO D-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 |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Nursing Home Plan NC-F001 (PPO I-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 |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 2 - 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 |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Simple Open (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Assist Open (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Giveback Open (PPO) | 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 |
| HealthTeam Advantage Diabetes & Heart Care (HMO 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 Chronic Care (HMO C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Enhanced (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | 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 |
| Wellcare Simple (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Senior Care (HMO I-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 |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| HumanaChoice H5216-211 (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 |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | 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 |
| 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 |
| 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 |
| 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 |
| Erickson Advantage Signature (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Erickson Advantage Freedom (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Erickson Advantage Liberty (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Liberty Medicare Advantage (HMO C-SNP) | 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 H6622-061 (HMO-POS) | Tier 2 - Generic | ✓ | — | — | PA |
| Alignment Health AVA (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Choice H8145-004 (PFFS) | Tier 2 - Generic | ✓ | — | — | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Healthy Blue + Medicare (HMO-POS D-SNP) | 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 |
| DEVOTED DUAL 009 NC (HMO D-SNP) | 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 C-SNP PLUS 015 NC (HMO C-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | 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 |
| HealthSpring True Choice (PPO) | 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 CORE 001 NC (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| HealthSpring Preferred Plus (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| HealthSpring Preferred Savings (HMO) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| HealthSpring Preferred Select (HMO) | 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 TotalCare (HMO D-SNP) | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | 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 |
NC Medicaid PDL
2 plansNC State Health Plan
9 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via Azasan |
Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Azasan |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Azasan |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Imuran |
Tier 3 - Non-Preferred Brand | — | — | — | 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 |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AIAN Cost Share | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | Tier 2 - Generic | — | — | — | None |
| Gold Classic Standard | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Secure | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | Tier 2 - Generic | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | Tier 2 - Generic | — | — | — | None |
| Secure | Tier 2 - Generic | — | — | — | None |
| Silver Classic | Tier 2 - Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 2 - Generic | — | — | — | None |
UnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| 54332NC0060010 | Tier 1 - Preferred Generic | — | — | — | None |
| 54332NC0060009 | Tier 1 - Preferred Generic | — | — | — | None |
| 54332NC0060008 | Tier 1 - Preferred Generic | — | — | — | None |
| 54332NC0030042 | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |