calcitriol external
3 MCG — Ointment
Also known as:
Calcitriol External Ointment
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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.
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 | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
Medicare Part D
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Troy Medicare (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Signature Giveback (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| HealthSpring True Choice (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred Select (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred Savings (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred Plus (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring TotalCare (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Value Plus (HMO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Prime (HMO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Signature Care (HMO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Enhanced (HMO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Signature Extra (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 800 per 28 days | PA | QL |