carbamazepine
Generic: Epitol
100 mg, 100 mg/5 mL, 100 mg/5 mL (5 mL), 200 mg, 200 mg/10 mL, 400 mg — Extended Release Tablet
Also known as:
carbamazepine oral suspension 100
carbamazepine oral tablet
carbamazepine oral tablet chewable
Carbatrol
carbamazepine cap er 12hr 100 mg, 200 mg, 300 mg
carbamazepine susp 100 mg/5ml
carbamazepine tab er 12hr 100 mg, 200 mg, 400 mg
carbamazepine tab 200 mg
Carbamazepine 100 Mg Chewable Tablet
Carbamazepine 100 Mg/5 Ml Oral Suspension
Carbamazepine 200 Mg Tablet
Carbamazepine Er 100 Mg Capsule
Carbamazepine Er 200 Mg Capsule
Carbamazepine Er 300 Mg Capsule
Carbamazepine Er 100 Mg Tablet
Carbamazepine Er 200 Mg Tablet
Carbamazepine Er 400 Mg Tablet
EPITOL
TEGRETOL
CARBAMAZEPINE ER
TEGRETOL XR
carBAMazepine ER Oral Tablet Extended Release
carBAMazepine ER Oral Capsule Extended Release
carBAMazepine Oral Tablet Chewable
carBAMazepine Oral Suspension
carBAMazepine 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)
131 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Signature Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Signature Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Signature Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Gold
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Silver
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Gold with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Expanded Bronze with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Streamlined Silver
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Streamlined Silver with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold
via Epitol |
Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Signature Gold | Tier 2 - Generic | — | — | ✓ | QL |
|
Complete Gold + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
| Streamlined Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced CHF Heart Care Silver $0 Rx Options | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver $0 Rx Options | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Streamlined Silver | Tier 2 - Generic | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | ✓ | QL |
|
Signature Silver with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
| Signature Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Signature Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Signature Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Signature Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Signature Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Signature Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Gold + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Silver + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Expanded Bronze + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Expanded Bronze
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
| Signature Silver | Tier 2 - Generic | — | — | ✓ | QL |
| Signature Expanded Bronze | Tier 2 - Generic | — | — | ✓ | QL |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Gold + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Complete Gold
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Silver + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Expanded Bronze + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Gold
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Everyday Bronze with Atrium Health
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Focused Silver with Atrium Health
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Expanded Bronze with Atrium Health
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Gold with Atrium Health
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Silver with Atrium Health
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Complete Gold with Atrium Health
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Elite Bronze with Atrium Health
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Silver
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Signature Expanded Bronze
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Elite Bronze
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Everyday Bronze
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Tegretol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Focused Silver with Atrium Health
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Expanded Bronze + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Silver + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Gold + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Clear Silver with $0 Insulin Options
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Elite Bronze
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Everyday Bronze
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Complete Gold
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Streamlined Silver with Atrium Health
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Streamlined Silver
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Expanded Bronze
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Silver
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Gold
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Everyday Bronze with Atrium Health
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Elite Bronze + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Elite Bronze with Atrium Health
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Expanded Bronze with Atrium Health
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Silver with Atrium Health
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Signature Gold with Atrium Health
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Complete Gold with Atrium Health
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Complete Gold + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Everyday Bronze + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Equetro |
Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
AmeriHealth Caritas NC
31 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
Blue Cross Blue Shield Federal
4 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Tegretol-Xr |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Tegretol |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Tegretol-Xr |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Tegretol |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Blue Cross Blue Shield of NC
15 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Care 2026
via Carbatrol |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Advantage 2026
via Tegretol |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Tegretol |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Local 2026
via Tegretol |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Care 2026
via Tegretol |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Value 2026
via Tegretol |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Advantage 2026
via Tegretol-Xr |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Tegretol-Xr |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Local 2026
via Tegretol-Xr |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Care 2026
via Tegretol-Xr |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Value 2026
via Tegretol-Xr |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Advantage 2026
via Carbatrol |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Carbatrol |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Local 2026
via Carbatrol |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Value 2026
via Carbatrol |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
Cigna
40 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Silver 3600 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 5000 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 5000 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Bronze
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3000 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 5500 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 3500 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Silver
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 5000 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 6500 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 6000 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| Connect Silver 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 2200 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| Connect Silver 3000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect myDiabetesCare Silver | Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 5500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 6500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect myDiabetesCare Bronze | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Gold RD 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
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver CMS Standard
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze CMS Standard
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold RD CMS Standard
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD CMS Standard
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| Connect Gold 1500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
|
Connect Gold CMS Standard
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver 3600 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
|
Connect Gold 1500 Indiv Med Deductible
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
Medicare Part D
283 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via carbamazepine er |
Tier 1 - Preferred Generic | — | — | — | None |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via carbamazepine er |
Tier 1 - Preferred Generic | — | — | — | None |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via carbamazepine er |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via carbamazepine er |
Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via carbamazepine er |
Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via carbamazepine er |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via carbamazepine er |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via carbamazepine er |
Tier 1 - Preferred Generic | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 2 - Generic | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| Troy Medicare (HMO) | Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| Senior Care (HMO I-SNP) | Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| HealthSpring Preferred (HMO) | Tier 2 - Generic | — | — | — | None |
| Alignment Health Platinum (HMO) | Tier 2 - Generic | — | — | — | None |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Alignment Health smartHMO (HMO) | Tier 2 - Generic | — | — | — | None |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 2 - Generic | — | — | — | None |
| Alignment Health Platinum Select (HMO) | Tier 2 - Generic | — | — | — | None |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| HealthSpring Preferred Select (HMO) | Tier 2 - Generic | — | — | — | None |
| HealthSpring Preferred Savings (HMO) | Tier 2 - Generic | — | — | — | None |
| HealthSpring Preferred Plus (HMO) | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Giveback Open (PPO) | Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via carbamazepine er |
Tier 2 - Generic | — | — | — | None |
| Wellcare Simple (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Erickson Advantage Freedom (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Signature (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Liberty (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring TotalCare (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Platinum (HMO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health AVA (PPO)
via carbamazepine er |
Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Plan I (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Plan II (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Assist Open (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
Troy Medicare (HMO)
via Equetro |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Experience Health Medicare Advantage (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Blue Medicare Essential (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Blue Medicare Choice (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Blue Medicare Enhanced (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Blue Medicare Essential Plus (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Blue Medicare PPO Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 008 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 005 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 003 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 001 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CORE 001 NC (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature Giveback (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature Extra (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Enhanced (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature Care (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Prime (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Value Plus (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H1036-137 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5216-211 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Full Access H5525-034 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-049 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-050 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-070 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-083 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Choice H8145-004 (PFFS) | Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via carbamazepine er |
Tier 4 - Non-Preferred | — | — | — | None |
NC Medicaid PDL
4 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC Medicaid Preferred Drug List 2026
via Equetro |
Preferred | — | — | — | None |
| NC Medicaid Preferred Drug List 2026 | Non-Preferred | — | — | — | None |
|
NC Medicaid Preferred Drug List 2026
via Carbatrol |
Non-Preferred | — | — | — | None |
|
NC Medicaid Preferred Drug List 2026
via Epitol |
Non-Preferred | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 70/30 Standard PPO 2026
via Tegretol |
Not Covered | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Tegretol |
Not Covered | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Tegretol |
Not Covered | — | — | — | None |
Oscar Health
56 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Silver Classic | Tier 2 - Generic | — | — | — | None |
| Secure | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | 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 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 |
| 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 |
| Bronze Classic Standard | Tier 2 - Generic | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| AIAN Cost Share | Tier 2 - Generic | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 2 - Generic | — | — | — | None |
|
Silver Classic Standard
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic Standard
via Epitol |
Tier 2 - Generic | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | 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 Elite + PCP Saver Plus | Tier 2 - Generic | — | — | — | None |
|
AIAN Cost Share | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
AIAN Cost Share
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Diabetes | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Gold Elite Saver Plus | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple PCP Saver | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Diabetes | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic 4700 | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Secure | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Diabetes
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Gold Elite Saver Plus
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple PCP Saver
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic 4700
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Secure
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Gold Classic Standard | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic Standard | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic Standard | with Atrium Health
via Epitol |
Tier 2 - Generic | — | — | — | None |
|
Gold Classic Standard
via Epitol |
Tier 2 - Generic | — | — | — | None |
TRICARE
1 planUnitedHealthcare
34 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Epitol |
Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Standard (HSA, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |