brimonidine

0.0033 MG — Gel

Also known as: Alphagan

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 20 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Standard Silver with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Everyday Bronze	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Elite Bronze	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Expanded Bronze	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Silver	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Gold	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Focused Silver with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Complete Gold with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Gold with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Elite Bronze + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Expanded Bronze + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Complete Gold	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL

AmeriHealth Caritas NC

9 plans

Source: CMS QHP JSON · Checked: 20 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Gold Premier + No Referrals via Alphagan	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Silver Essential + No Referrals via Alphagan	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via Alphagan	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Gold Signature + No Referrals via Alphagan	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Signature + No Referrals via Alphagan	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Signature + No Referrals via Alphagan	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Essential + No Referrals via Alphagan	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Premier + No Referrals via Alphagan	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Premier + No Referrals via Alphagan	Brand-Preferred	—	—	✓	QL

Blue Cross Blue Shield Federal

2 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 20 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026 via Mirvaso	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Standard Option 2026 via Mirvaso	Tier 3 - Non-Preferred Brand	✓	—	—	PA

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 20 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Local 2026 via Mirvaso	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Value 2026 via Mirvaso	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Advantage 2026 via Mirvaso	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Mirvaso	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Care 2026 via Mirvaso	Tier 2 - Medium Cost Generic/Brand	—	—	—	None

Cigna

20 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 20 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Bronze CMS Standard	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver 3500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver 4400 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard	Tier 2 - Generic	—	—	—	None

Medicare Part D

40 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 20 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Erickson Advantage Liberty (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0016 (PPO) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Wellcare Dual Liberty Open (PPO D-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Wellcare Assist Open (PPO) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Wellcare Dual Access (HMO-POS D-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Wellcare Dual Liberty (HMO-POS D-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage Access from UHC NC-23 (PPO) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-S2 (PPO D-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-S001 (PPO D-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0017 (PPO) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Wellcare Dual Reserve (HMO-POS D-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-D001 (HMO-POS D-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Wellcare Simple Open (PPO) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Wellcare Simple (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Wellcare Giveback Open (PPO) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Champion (HMO-POS C-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
UHC Complete Care NC-28 (HMO-POS C-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
UHC Complete Care NC-27 (HMO-POS C-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
UHC Complete Care NC-25 (HMO-POS C-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-S3 (HMO-POS D-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-24 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Signature (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Guardian (HMO-POS I-SNP) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Freedom (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0019 (PPO) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0004 (PPO) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0001 (PPO) via Alphagan	Tier 3 - Preferred Brand	—	—	—	None

NC Medicaid PDL

2 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 20 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Preferred	—	—	—	None
NC Medicaid Preferred Drug List 2026 via Mirvaso	Non-Preferred	—	—	—	None

NC State Health Plan

3 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 20 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 via Mirvaso	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Mirvaso	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Mirvaso	Not Covered	—	—	—	None

Oscar Health

56 plans

Source: CMS QHP JSON · Checked: 20 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
AIAN Cost Share via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
AIAN Cost Share \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Classic	Tier 4 - Non-Preferred	—	—	—	None
Bronze Classic 4700	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple PCP Saver	Tier 4 - Non-Preferred	—	—	—	None
Gold Elite Saver Plus	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple Diabetes	Tier 4 - Non-Preferred	—	—	—	None
Secure \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Bronze Classic 4700 \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Silver Classic \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple Diabetes \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Gold Elite Saver Plus \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
AIAN Cost Share	Tier 4 - Non-Preferred	—	—	—	None
AIAN Cost Share \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Bronze Classic Standard via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Classic Standard via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Gold Classic Standard via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Bronze Classic Standard \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Classic Standard \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Gold Classic Standard \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Bronze Elite + PCP Saver Plus via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Classic via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Secure via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Bronze Classic 4700 via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple PCP Saver via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Gold Elite Saver Plus via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple Diabetes via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Secure \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Bronze Classic 4700 \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Classic \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple Diabetes \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Gold Elite Saver Plus \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health via Alphagan	Tier 4 - Non-Preferred	—	—	—	None
Bronze Classic Standard	Tier 4 - Non-Preferred	—	—	—	None
Silver Classic Standard	Tier 4 - Non-Preferred	—	—	—	None
Gold Classic Standard	Tier 4 - Non-Preferred	—	—	—	None
Bronze Classic Standard \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Silver Classic Standard \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Gold Classic Standard \| with Atrium Health	Tier 4 - Non-Preferred	—	—	—	None
Bronze Elite + PCP Saver Plus	Tier 4 - Non-Preferred	—	—	—	None
Secure	Tier 4 - Non-Preferred	—	—	—	None

UnitedHealthcare

13 plans

Source: PDF · Formulary date: Jun 23, 2026 · Checked: 20 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Bronze Standard (No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Silver Standard (No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Bronze Standard+ Dental + Vision (No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
UHC Gold Standard (No Referrals)	Tier 4 - Non-Preferred	—	—	✓	QL