ciclesonide

Generic: Alvesco

37 mcg/actuation, 50 mcg — Spray

NASAL ALLERGY AGENTS

Also known as: OMNARIS ZETONNA
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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: 22 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Gold with Atrium Health
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Gold with Atrium Health + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Silver with Atrium Health + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Gold + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Silver + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Complete Gold + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Complete Gold
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Clear Silver with $0 Insulin Options
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Silver
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Gold
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze with Atrium Health
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Standard Silver with Atrium Health
via Alvesco 		Tier 4 - Non-Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 22 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via Omnaris 		Tier 2 - Preferred Brand — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 22 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026
via Alvesco 		Tier 2 - Preferred Brand — — — None
Cigna Plus NC 4-Tier Formulary 2026
via Zetonna 		Tier 3 - Non-Preferred — ✓ — ST
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 22 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Alvesco 		Tier 1 - Preferred Generic — — ✓ 12.2 per 30 days QL
PruittHealth Premier (HMO I-SNP)
via Alvesco 		Tier 1 - Preferred Generic — — ✓ 12.2 per 30 days QL
Longevity Health Plan (HMO I-SNP)
via Alvesco 		Tier 1 - Preferred Generic — — ✓ 12.2 per 30 days QL
NHC Advantage (HMO I-SNP)
via Alvesco 		Tier 1 - Preferred Generic — — ✓ 12.2 per 30 days QL
Liberty Medicare Dual Plan (HMO D-SNP)
via Alvesco 		Tier 1 - Preferred Generic — — ✓ 12.2 per 30 days QL
Senior Care (HMO I-SNP)
via Alvesco 		Tier 3 - Preferred Brand — — ✓ 12.2 per 30 days QL
Liberty Medicare Advantage (HMO C-SNP)
via Alvesco 		Tier 3 - Preferred Brand — — ✓ 12.2 per 30 days QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
Aetna Medicare Signature (HMO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Dual (HMO D-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Signature (HMO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Value Plus (HMO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Prime (HMO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Signature Care (HMO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Enhanced (HMO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Signature (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Enhanced (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Enhanced (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Signature Extra (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Signature (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Signature (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Signature Giveback (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Signature (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.20 per 30 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED DUAL 009 NC (HMO D-SNP)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED CORE 001 NC (HMO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED GIVEBACK 002 NC (HMO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED GIVEBACK 012 NC (HMO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED CHOICE 001 NC (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED CHOICE 003 NC (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED CHOICE 005 NC (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED CHOICE 008 NC (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Alvesco 		Tier 4 - Non-Preferred — — ✓ 12.2 per 30 days QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 22 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Alvesco 		Preferred — — — None
NC Medicaid Preferred Drug List 2026
via Omnaris 		Non-Preferred — ✓ — ST
NC Medicaid Preferred Drug List 2026
via Zetonna 		Non-Preferred — ✓ — ST
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 22 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Omnaris 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Omnaris 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Omnaris 		Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 22 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary ✓ — — PA
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 22 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026
via Alvesco 		Tier 4 - Higher Cost — ✓ ✓ ST | QL
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