CABENUVA 400 MG / 600 MG
Generic: cabotegravir
200 MG — Suspension
Human Immunodeficiency Virus 1 Non-Nucleoside Analog Reverse Transcriptase Inhibitor
Also known as:
Cabenuva Intramuscular Suspension Extended Release
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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)
102 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Elite Bronze
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Everyday Bronze
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Complete Gold
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Streamlined Silver | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Streamlined Silver with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Enhanced CHF Heart Care Silver $0 Rx Options | Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Focused Silver with Atrium Health
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Complete Gold with Atrium Health
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Expanded Bronze with Atrium Health
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Silver with Atrium Health
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Gold with Atrium Health
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
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 | — | — | ✓ | QL |
|
Elite Bronze + Vision + Adult Dental
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 |
|
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 | — | — | ✓ | QL |
|
Signature Expanded Bronze + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Silver + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Gold + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | — | None |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Streamlined Silver
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Streamlined Silver with Atrium Health
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Gold + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Silver + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Expanded Bronze + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Elite Bronze + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Everyday Bronze + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Complete Gold + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Gold with Atrium Health
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Silver with Atrium Health
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Expanded Bronze with Atrium Health
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Complete Gold with Atrium Health
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Focused Silver with Atrium Health
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Gold
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Silver
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Everyday Bronze
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Elite Bronze
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Complete Gold
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Expanded Bronze
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Clear Silver with $0 Insulin Options
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Expanded Bronze
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Silver
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Signature Gold
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Clear Silver with $0 Insulin Options
via Apretude |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Streamlined Silver with Atrium Health
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Streamlined Silver
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via CABENUVA 600 MG / 900 MG |
Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Complete Gold | Tier 4 - Non-Preferred | — | — | — | None |
| Enhanced Asthma/COPD Care Silver $0 Rx 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 |
| Signature Expanded Bronze | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Signature Silver | Tier 4 - Non-Preferred | — | — | — | None |
| Signature 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 | — | — | — | None |
| Complete Gold with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Signature Expanded Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Signature Silver with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Signature Gold with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Elite Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| 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 |
| Signature Expanded Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Signature Silver + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Signature Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Signature Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Signature Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Signature Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
AmeriHealth Caritas NC
44 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Apretude |
Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Vocabria |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Vocabria |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Vocabria |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Vocabria |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Vocabria |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Vocabria |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Vocabria |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Vocabria |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Vocabria |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via CABENUVA 600 MG / 900 MG |
Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Brand-Preferred | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Vocabria |
Brand-Preferred | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Vocabria |
Brand-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Brand-Preferred | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via CABENUVA 600 MG / 900 MG |
Brand-Preferred | — | — | ✓ | QL |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Apretude |
Tier 2 - Preferred Brand | ✓ | — | — NCTM for HIV PrEP | PA |
|
BCBS Federal Standard Option 2026
via Apretude |
Tier 2 - Preferred Brand | ✓ | — | — NCTM for HIV PrEP | PA |
|
BCBS Federal Focus 2026
via Apretude |
Tier 2 - Preferred Brand | ✓ | — | — NCTM for HIV PrEP | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Care 2026
via Apretude |
Tier A - ACA $0 Copay | — | — | — Limited Distribution | None |
|
BCBSNC Blue Value 2026
via Apretude |
Tier A - ACA $0 Copay | — | — | — Limited Distribution | None |
|
BCBSNC Blue Advantage 2026
via Apretude |
Tier A - ACA $0 Copay | — | — | — Limited Distribution | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Apretude |
Tier A - ACA $0 Copay | — | — | — Limited Distribution | None |
|
BCBSNC Blue Local 2026
via Apretude |
Tier A - ACA $0 Copay | — | — | — Limited Distribution | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via Apretude |
Tier 0 - $0 Copay (ACA Preventive) | — | — | ✓ | QL |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Apretude |
Tier 0 - $0 Copay (ACA Preventive) | — | — | ✓ | QL |
|
NC State Health Plan - HDHP 2026
via Apretude |
Tier 0 - $0 Copay (ACA Preventive) | — | — | ✓ | QL |
Oscar Health
84 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Secure | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Gold Classic Standard
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Bronze Classic Standard | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Classic Standard | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Bronze Elite + PCP Saver Plus
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Classic
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Secure
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Bronze Classic 4700
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Simple PCP Saver
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Gold Elite Saver Plus
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
AIAN Cost Share
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
AIAN Cost Share | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Simple Diabetes
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Bronze Classic Standard
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Gold Classic Standard | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Classic Standard
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Simple Diabetes | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Classic | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Simple PCP Saver | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Gold Elite Saver Plus | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Bronze Simple Diabetes | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Bronze Classic 4700 | with Atrium Health
via Apretude |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Gold Elite Saver Plus | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Simple Diabetes | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
Secure
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
| AIAN Cost Share | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| AIAN Cost Share | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
Silver Classic
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 Simple PCP Saver
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 Women's Health with Menopause Benefits | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Classic Standard | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Classic Standard | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple Diabetes | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Gold Elite Saver Plus | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple PCP Saver | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Classic 4700 | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Secure | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Classic | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
AIAN Cost Share | 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 |
|
Silver Simple Women's Health with Menopause 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 Breathe Easy with Enhanced COPD Benefits | 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 |
|
Gold Elite Saver Plus | 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 |
|
Silver Simple Diabetes | 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 |
|
Bronze Elite + PCP Saver Plus | 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 |
|
Secure | 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 Breathe Easy with Enhanced COPD Benefits | 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 |
|
Silver Classic Standard | with Atrium Health
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 |
|
Gold 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 |
|
Bronze Classic Standard
via CABENUVA 600 MG / 900 MG |
Tier 3 - Preferred Brand | — | — | ✓ | QL |
|
Silver Simple Diabetes
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 |
| Gold Classic Standard | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Classic Standard | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Classic Standard | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Gold Classic Standard | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Secure | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Classic 4700 | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Classic | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple Diabetes | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple PCP Saver | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |