chlorzoxazone

Generic: Lorzone

250mg, 500mg — Tablet

Also known as: chlorzoxazone oral tablet 500 mg Parafon Forte chlorzoxazone tabs 250mg, 500mg chlorzoxazone tabs 375mg, 750mg chlorzoxazone tab 500 mg Chlorzoxazone 500 Mg Tablet chlorzoxazone tabs 500mg Chlorzoxazone Tabs 375mg, 750mg Chlorzoxazone 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)

34 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 13 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Signature Gold with Atrium Health	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
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Elite Bronze 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
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 Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Signature Expanded Bronze with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Signature Silver with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Complete Gold	Tier 2 - Generic	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options	Tier 2 - Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Streamlined Silver	Tier 2 - Generic	—	—	✓	QL
Streamlined Silver with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze	Tier 2 - Generic	—	—	✓	QL
Elite Bronze	Tier 2 - Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options	Tier 2 - Generic	—	—	✓	QL
Signature Expanded Bronze	Tier 2 - Generic	—	—	✓	QL
Signature Silver	Tier 2 - Generic	—	—	✓	QL
Signature Gold	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health	Tier 2 - Generic	—	—	✓	QL

AmeriHealth Caritas NC

11 plans

Source: CMS QHP JSON · Formulary date: Sep 22, 2026 · Checked: 13 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 2 - Generic	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 2 - Generic	—	—	✓	QL
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 13 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026	Tier 1 - Generic	—	—	—	None
BCBS Federal Standard Option 2026	Tier 1 - Generic	—	—	—	None
BCBS Federal Basic Option 2026	Tier 1 - Generic	—	—	—	None

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 13 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Local 2026	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Care 2026	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Value 2026	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Advantage 2026	Tier 2 - Medium Cost Generic/Brand	—	—	—	None

Cigna

20 plans

Source: PDF · Formulary date: Oct 7, 2026 · Checked: 13 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver 3600 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard	Tier 2 - Generic	—	—	—	None

Medicare Part D

84 plans

Source: CMS QHP JSON · Formulary date: Sep 16, 2026 · Checked: 13 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NHC Advantage (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 180 per 30 days	PA \| QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	✓ 180 per 30 days	QL
PruittHealth Premier (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 180 per 30 days	PA \| QL
Liberty Medicare Dual Plan (HMO D-SNP)	Tier 1 - Preferred Generic	—	—	✓ 180 per 30 days	QL
Aetna Medicare Chronic Care (HMO C-SNP)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Full Dual Care (HMO D-SNP)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Signature Care (HMO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Prime (HMO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Value Plus (HMO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Signature (HMO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Dual (HMO D-SNP)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Signature (HMO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Enhanced (PPO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Enhanced (PPO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Signature Extra (PPO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Signature Giveback (PPO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Liberty Medicare Advantage (HMO C-SNP)	Tier 2 - Generic	—	—	✓ 180 per 30 days	QL
Troy Medicare (HMO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Senior Care (HMO I-SNP)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Chronic Care Value (HMO C-SNP)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Aetna Medicare Enhanced (HMO)	Tier 2 - Generic	✓	—	✓ 180 per 30 days	PA \| QL
Erickson Advantage Guardian (HMO-POS I-SNP)	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
UHC Complete Care NC-25 (HMO-POS C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)	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 Signature (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Champion (HMO-POS C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Freedom (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Liberty (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	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
Humana Gold Choice H8145-004 (PFFS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-061 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-060 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-057 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H6622-027 (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-026 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-025 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-083 (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H5525-072 (PPO D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-070 (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
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 - Diabetes and Heart (HMO C-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

NC Medicaid PDL

2 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 13 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Lorzone	Non-Preferred	—	—	—	None
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	—	—	None

NC State Health Plan

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 13 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026	Not Covered	—	—	—	None

Oscar Health

28 plans

Source: CMS QHP JSON · Checked: 13 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Silver Simple PCP Saver	Tier 2 - Generic	—	—	—	None
Gold Elite Saver Plus	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
Gold Elite Saver Plus \| 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
AIAN Cost Share	Tier 2 - Generic	—	—	—	None
AIAN Cost Share \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700	Tier 2 - Generic	—	—	—	None
Secure	Tier 2 - Generic	—	—	—	None
Silver Classic	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus	Tier 2 - Generic	—	—	—	None

UnitedHealthcare

17 plans

Source: PDF · Formulary date: Sep 23, 2026 · Checked: 12 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
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, Dental + Vision, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, 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 Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, 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 Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, 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 Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, 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 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, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Silver Standard ($8 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 Standard ($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, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None