Conjugated estrogen

Tablet

Oral / Transdermal Estrogen Agents And Other

Also known as: Premarin
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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: 6 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Gold
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Everyday Bronze with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Elite Bronze with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Focused Silver with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Complete Gold with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Expanded Bronze with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Silver with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Silver
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Gold with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Complete Gold + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Elite Bronze + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Silver + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Gold + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Standard Expanded Bronze
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Clear Silver with $0 Insulin Options
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Elite Bronze
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Everyday Bronze
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Complete Gold
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Source: CMS QHP JSON  ·  Checked: 6 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Signature + No Referrals
via Premarin 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Gold Premier + No Referrals
via Premarin 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Silver Essential + No Referrals
via Premarin 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Silver Premier + No Referrals
via Premarin 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Premarin 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Premarin 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Gold Signature + No Referrals
via Premarin 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Premarin 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Premarin 		Tier 4 - Non-Preferred — ✓ — ST
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Premarin 		Tier 4 - Non-Preferred — ✓ — ST
Source: PDF  ·  Formulary date: Aug 7, 2026  ·  Checked: 6 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026
via Premarin 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Premarin 		Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: Sep 1, 2026  ·  Checked: 6 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via Premarin 		Tier 3 - High Cost Brand — — — None
BCBSNC Blue Care 2026
via Premarin 		Tier 3 - High Cost Brand — — — None
BCBSNC Blue Local 2026
via Premarin 		Tier 3 - High Cost Brand — — — None
BCBSNC Blue Value 2026
via Premarin 		Tier 3 - High Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Premarin 		Tier 3 - High Cost Brand — — — None
Source: PDF  ·  Formulary date: Sep 18, 2026  ·  Checked: 6 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver RD CMS Standard
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Bronze 6500 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Bronze 5500 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Silver 5000 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Silver 3600 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Silver 3000 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Bronze CMS Standard
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Silver CMS Standard
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Gold CMS Standard
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Bronze
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Silver
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Gold 1500 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD CMS Standard
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 3500 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 5000 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 2200 Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Gold RD CMS Standard
via Premarin 		Tier 4 - Non-Preferred — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via Premarin 		Tier 4 - Non-Preferred — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 6 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP)
via Premarin 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Premarin 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Premarin 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Premarin 		Tier 1 - Preferred Generic — — — None
Experience Health Medicare Advantage (HMO)
via Premarin 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Savings (HMO)
via Premarin 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Select (HMO)
via Premarin 		Tier 3 - Preferred Brand — — — None
HealthSpring True Choice (PPO)
via Premarin 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP)
via Premarin 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred (HMO)
via Premarin 		Tier 3 - Preferred Brand — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Premarin 		Tier 3 - Preferred Brand — — — None
Healthy Blue + Medicare (HMO-POS D-SNP)
via Premarin 		Tier 3 - Preferred Brand — — — None
Blue Medicare Essential (HMO)
via Premarin 		Tier 3 - Preferred Brand — — — None
Blue Medicare Choice (HMO)
via Premarin 		Tier 3 - Preferred Brand — — — None
Blue Medicare Enhanced (HMO-POS)
via Premarin 		Tier 3 - Preferred Brand — — — None
Blue Medicare Essential Plus (HMO-POS)
via Premarin 		Tier 3 - Preferred Brand — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Premarin 		Tier 3 - Preferred Brand — — — None
Troy Medicare (HMO)
via Premarin 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via Premarin 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Plus (HMO)
via Premarin 		Tier 3 - Preferred Brand — — — None
Blue Medicare PPO Enhanced (PPO)
via Premarin 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Humana Gold Plus H1036-137 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-233 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Dual Select H1036-307 (HMO D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-335 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S001 (PPO D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Dual Complete NC-S2 (PPO D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (HMO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Dual (HMO D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (HMO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Value Plus (HMO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Prime (HMO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature Care (HMO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Full Dual Care (HMO D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Chronic Care (HMO C-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (HMO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
HumanaChoice Giveback H5216-017 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5216-211 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature Extra (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature Giveback (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Full Access H5525-034 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
HumanaChoice Giveback H5525-035 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-049 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-050 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-070 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Dual Select H5525-072 (PPO D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-083 (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Erickson Advantage Signature (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Erickson Advantage Guardian (HMO-POS I-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Erickson Advantage Champion (HMO-POS C-SNP)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Erickson Advantage Freedom (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Erickson Advantage Liberty (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Humana Gold Plus H6622-025 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-026 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-057 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-060 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-061 (HMO-POS)
via Premarin 		Tier 4 - Non-Preferred — — — None
Humana Gold Choice H8145-004 (PFFS)
via Premarin 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan I (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan II (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Vitality Plan (PPO)
via Premarin 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 6 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Premarin 		Preferred — — — None
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 6 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Premarin 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Premarin 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Premarin 		Not Covered — — — None
Source: CMS QHP JSON  ·  Checked: 6 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Simple Chronic Care CKM | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic Standard | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic Standard | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Gold Classic Standard | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Chronic Care CKM | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Secure | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic 4700 | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Elite + PCP Saver Plus | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Diabetes | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple PCP Saver | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Gold Elite Saver Plus | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Diabetes | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
AIAN Cost Share
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
AIAN Cost Share | with Atrium Health
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Elite + PCP Saver Plus
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Secure
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic 4700
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple PCP Saver
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Gold Elite Saver Plus
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Diabetes
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic Standard
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic Standard
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Gold Classic Standard
via Premarin 		Tier 3 - Preferred Brand — — ✓ QL
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 6 hours, 7 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)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Premarin 		Tier 4 - Non-Preferred — — — None
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