chlorothiazide

Generic: Diuril

500 MG — VIAL (EA)

Thiazide Diuretic

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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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 21 hours, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Enhanced CHF Heart Care Silver $0 Rx Options
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Everyday Bronze
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Elite Bronze
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Clear Silver with $0 Insulin Options
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Expanded Bronze
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Silver
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Gold
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Everyday Bronze with Atrium Health
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Elite Bronze with Atrium Health
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Focused Silver with Atrium Health
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Complete Gold with Atrium Health
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Expanded Bronze with Atrium Health
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Silver with Atrium Health
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Gold with Atrium Health
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Complete Gold + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Elite Bronze + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Expanded Bronze + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Silver + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Gold + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Silver with Atrium Health + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Signature Gold with Atrium Health + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Complete Gold
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Streamlined Silver
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Streamlined Silver with Atrium Health
via Diuril 		Tier 3 - Preferred Brand — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Oct 13, 2026  ·  Checked: 21 hours, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus Tier 2 - Generic — — — None
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
Silver Simple Diabetes 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 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
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
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
Silver Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 2 - Generic — — — None
69803NC0010074 Tier 2 - Generic — — — None
69803NC0010075 Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health Tier 2 - Generic — — — None
69803NC0010076 Tier 2 - Generic — — — None
69803NC0010077 Tier 2 - Generic — — — None
69803NC0010078 Tier 2 - Generic — — — None
69803NC0010079 Tier 2 - Generic — — — None
69803NC0010080 Tier 2 - Generic — — — None
69803NC0010081 Tier 2 - Generic — — — None
69803NC0010082 Tier 2 - Generic — — — None
69803NC0010083 Tier 2 - Generic — — — None
69803NC0010084 Tier 2 - Generic — — — None
69803NC0010085 Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision Tier 2 - Generic — — — None
Bronze Simple Diabetes Tier 2 - Generic — — — None
Silver Core Plan Tier 2 - Generic — — — None
Silver Core Plan | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Diabetes with Adult Dental & Vision Tier 2 - Generic — — — None
69803NC0010108 Tier 2 - Generic — — — None
69803NC0010109 Tier 2 - Generic — — — None
69803NC0010110 Tier 2 - Generic — — — None
69803NC0010111 Tier 2 - Generic — — — None
69803NC0010112 Tier 2 - Generic — — — None
69803NC0010113 Tier 2 - Generic — — — None
69803NC0010114 Tier 2 - Generic — — — None
69803NC0010115 Tier 2 - Generic — — — None
69803NC0010116 Tier 2 - Generic — — — None
69803NC0010117 Tier 2 - Generic — — — None
Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health Tier 2 - Generic — — — None
69803NC0010084
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Simple Diabetes
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Core Plan
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Core Plan | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Simple Diabetes with Adult Dental & Vision
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010108
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010109
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010110
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010111
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010112
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010113
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010114
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010115
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010116
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010117
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Classic | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Simple Diabetes | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Simple PCP Saver | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Simple Diabetes | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010074
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010075
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010076
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010077
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010078
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010079
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010080
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010081
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010082
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010083
via Diuril 		Tier 4 - Non-Preferred — — — None
69803NC0010085
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Elite + PCP Saver Plus
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Classic
via Diuril 		Tier 4 - Non-Preferred — — — None
Secure
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Classic 4700
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Simple PCP Saver
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Simple Diabetes
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Classic Standard
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Classic Standard
via Diuril 		Tier 4 - Non-Preferred — — — None
Gold Classic Standard
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Classic Standard | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Silver Classic Standard | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Gold Classic Standard | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Secure | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Classic 4700 | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via Diuril 		Tier 4 - Non-Preferred — — — None
Source: Excel (XLSX)  ·  Formulary date: Sep 23, 2026  ·  Checked: 21 hours, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Generic Formulary ✓ — — PA PA: TPA - ALDACTONE TABLET FOR MALE PTS 11 THRU 18 YRS OF AGE W/O QUALIFIERS IN 360 DAYS REQ PA
TRICARE Uniform Formulary 2026
via Diuril 		Tier 2 - Brand Formulary ✓ — — PA PA: TPA - ALDACTONE TABLET FOR MALE PTS 11 THRU 18 YRS OF AGE W/O QUALIFIERS IN 360 DAYS REQ PA
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 21 hours, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via Diuril 		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)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via Diuril 		Tier 3 - Preferred Brand — — — None
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