celecoxib
10 mg/mL, 100 mg, 120 mg/4.8 mL (25 mg/mL), 200 mg, 400 mg, 50 mg — Capsule
Also known as:
celecoxib oral
Celebrex
celecoxib caps 50mg, 100mg, 200mg, 400mg
celecoxib cap 50 mg, 100 mg, 200 mg, 400 mg
Celecoxib 50 Mg Capsule
Celecoxib 100 Mg Capsule
Celecoxib 200 Mg Capsule
Celecoxib 400 Mg Capsule
VYSCOXA
ELYXYB
Celecoxib Oral Capsule
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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)
29 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | ✓ | QL |
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | ✓ | QL |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | ✓ | QL |
|
BCBS Federal Standard Option 2026
via Elyxyb |
Tier 3 - Non-Preferred Brand | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Celebrex |
Tier 3 - Non-Preferred Brand | — | — | ✓ | QL |
|
BCBS Federal Standard Option 2026
via Celebrex |
Tier 3 - Non-Preferred Brand | — | — | ✓ | QL |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Celebrex |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Celebrex |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Value 2026
via Celebrex |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Care 2026
via Celebrex |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Local 2026
via Celebrex |
Tier 1 - Lowest Cost Generic | — | — | — | None |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Silver CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver RD CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Gold CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze 5500 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect myDiabetesCare Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Gold 1500 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect myDiabetesCare Silver | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver 4400 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver 3000 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze 6500 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze RD CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Gold RD CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze CMS Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
| Connect Silver 3500 Indiv Med Deductible | Tier 2 - Generic | — | — | ✓ | QL |
Medicare Part D
140 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| Troy Medicare (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Senior Care (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| Liberty Medicare Advantage (HMO C-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 |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Humana Gold Choice H8145-004 (PFFS) | Tier 2 - Generic | — | — | — | None |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Erickson Advantage Signature (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Erickson Advantage Freedom (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Erickson Advantage Liberty (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Dual (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Value Plus (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Prime (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature Care (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Enhanced (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature Extra (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature Giveback (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring True Choice (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring TotalCare (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring Preferred (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring Preferred Select (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring Preferred Savings (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring Preferred Plus (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Wellcare Simple Open (PPO) | Tier 2 - Generic | — | — | — | None |
| Wellcare Simple (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Wellcare Giveback Open (PPO) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare PPO Enhanced (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Blue Medicare Essential Plus (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Blue Medicare Enhanced (HMO-POS) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Blue Medicare Choice (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Blue Medicare Essential (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Experience Health Medicare Advantage (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Alignment Health Platinum (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Alignment Health smartHMO (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Alignment Health Platinum Select (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Alignment Health AVA (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthTeam Advantage Plan I (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthTeam Advantage Plan II (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus H1036-137 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5216-211 (PPO) | Tier 2 - Generic | — | — | — | None |
| Humana Full Access H5525-034 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-049 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-050 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-070 (PPO) | Tier 2 - Generic | — | — | — | None |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-083 (PPO) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CORE 001 NC (HMO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE 001 NC (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE 003 NC (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE 005 NC (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE 008 NC (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Assist Open (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Reserve (HMO-POS D-SNP) | 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 |
NC Medicaid PDL
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC Medicaid Preferred Drug List 2026 | Preferred | — | — | — | None |
|
NC Medicaid Preferred Drug List 2026
via Celebrex |
Non-Preferred | — | — | — | None |
|
NC Medicaid Preferred Drug List 2026
via Vyscoxa |
Non-Preferred | — | — | — | None |
NC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Celebrex |
Not Covered | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Celebrex |
Not Covered | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Celebrex |
Not Covered | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AIAN Cost Share | Tier 2 - Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Secure | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | Tier 2 - Generic | — | — | — | None |
| Gold Classic Standard | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 2 - Generic | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | Tier 2 - Generic | — | — | — | None |
| Secure | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic | with Atrium Health | Tier 2 - Generic | — | — | — | None |
TRICARE
1 planUnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |