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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| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Clear Silver with $0 Insulin Options | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Expanded Bronze | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Silver | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Gold | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Everyday Bronze with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Elite Bronze with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Focused Silver with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Complete Gold with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Expanded Bronze with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Silver with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Gold with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Complete Gold + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Elite Bronze + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Complete Gold | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Expanded Bronze + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Enhanced Asthma/COPD Care Silver $0 Rx Options | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Everyday Bronze | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Enhanced CHF Heart Care Silver $0 Rx Options | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Streamlined Silver with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Streamlined Silver | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Clear Silver with $0 Insulin Options + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Elite Bronze | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Silver + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Gold + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Silver with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Signature Gold with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Elite + PCP Saver Plus | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Classic | Tier 5 - Specialty | ✓ | — | — | PA |
| Secure | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Classic 4700 | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple PCP Saver | Tier 5 - Specialty | ✓ | — | — | PA |
| Gold Elite Saver Plus | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple Diabetes | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Classic Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Classic Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Gold Classic Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Classic Standard | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Classic Standard | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Gold Classic Standard | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Secure | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Classic 4700 | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Classic | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple Diabetes | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple PCP Saver | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Gold Elite Saver Plus | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Simple Diabetes | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| AIAN Cost Share | Tier 5 - Specialty | ✓ | — | — | PA |
| AIAN Cost Share | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |