deflazacort

Generic: Jaythari

22.75mg — Tablet

Glucocorticoid Steroids, Oral

Also known as: Emflaza deflazacort susp 22.75mg/ml; tabs 6mg, 18mg, 30mg, 36mg deflazacort susp 22.75mg/ml; tabs 6mg, 18mg,
GoodRx Compare Prices

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: 13 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold Tier 5 - Specialty ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options Tier 5 - Specialty ✓ — — PA
Everyday Bronze Tier 5 - Specialty ✓ — — PA
Elite Bronze Tier 5 - Specialty ✓ — — PA
Clear Silver with $0 Insulin Options Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze Tier 5 - Specialty ✓ — — PA
Signature Silver Tier 5 - Specialty ✓ — — PA
Signature Gold Tier 5 - Specialty ✓ — — PA
Everyday Bronze with Atrium Health Tier 5 - Specialty ✓ — — PA
Elite Bronze with Atrium Health Tier 5 - Specialty ✓ — — PA
Focused Silver with Atrium Health Tier 5 - Specialty ✓ — — PA
Complete Gold with Atrium Health Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze with Atrium Health Tier 5 - Specialty ✓ — — PA
Signature Silver with Atrium Health Tier 5 - Specialty ✓ — — PA
Signature Gold with Atrium Health Tier 5 - Specialty ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Complete Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Everyday Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Elite Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Focused Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Complete Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Signature Silver + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Signature Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Signature Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Signature Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Complete Gold
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Everyday Bronze
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Elite Bronze
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Clear Silver with $0 Insulin Options
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Silver
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Gold
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Everyday Bronze with Atrium Health
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Elite Bronze with Atrium Health
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Focused Silver with Atrium Health
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Complete Gold with Atrium Health
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze with Atrium Health
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Silver with Atrium Health
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Gold with Atrium Health
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Complete Gold + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Everyday Bronze + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Elite Bronze + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Focused Silver with Atrium Health + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Complete Gold with Atrium Health + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Silver + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Gold + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Silver with Atrium Health + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Signature Gold with Atrium Health + Vision + Adult Dental
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Complete Gold
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Everyday Bronze
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Elite Bronze
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Clear Silver with $0 Insulin Options
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Silver
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Gold
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Everyday Bronze with Atrium Health
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Elite Bronze with Atrium Health
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Focused Silver with Atrium Health
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Complete Gold with Atrium Health
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze with Atrium Health
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Silver with Atrium Health
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Gold with Atrium Health
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Complete Gold + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Everyday Bronze + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Elite Bronze + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Focused Silver with Atrium Health + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Complete Gold with Atrium Health + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Silver + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Gold + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Silver with Atrium Health + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Signature Gold with Atrium Health + Vision + Adult Dental
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026 Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Focus 2026
via pyquvi 		Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Focus 2026
via Kymbee 		Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Focus 2026
via Jaythari 		Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Standard Option 2026
via Jaythari 		Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Basic Option 2026
via Jaythari 		Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Standard Option 2026 Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Basic Option 2026
via pyquvi 		Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Standard Option 2026
via pyquvi 		Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Basic Option 2026
via Kymbee 		Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Standard Option 2026
via Kymbee 		Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Basic Option 2026 Tier 4 - Preferred Specialty ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 13 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Signature (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Guardian (HMO-POS I-SNP)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Freedom (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Liberty (HMO-POS)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0004 (PPO)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0016 (PPO)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0017 (PPO)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0019 (PPO)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Signature (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Guardian (HMO-POS I-SNP)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Freedom (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Liberty (HMO-POS)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S001 (PPO D-SNP)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S2 (PPO D-SNP)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0001 (PPO)
via pyquvi 		Tier 5 - Specialty ✓ — — PA
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S001 (PPO D-SNP)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S2 (PPO D-SNP)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Jaythari 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Signature (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Guardian (HMO-POS I-SNP)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Freedom (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Erickson Advantage Liberty (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S001 (PPO D-SNP)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S2 (PPO D-SNP)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Troy Medicare (HMO)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Kymbee 		Tier 5 - Specialty ✓ — — PA
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 5 - Specialty ✓ — — PA
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 5 - Specialty ✓ — — PA
Erickson Advantage Signature (HMO-POS) Tier 5 - Specialty ✓ — — PA
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 5 - Specialty ✓ — — PA
Erickson Advantage Freedom (HMO-POS) Tier 5 - Specialty ✓ — — PA
Erickson Advantage Liberty (HMO-POS) Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Kymbee 		Non-Preferred — — — None
NC Medicaid Preferred Drug List 2026
via Jaythari 		Non-Preferred ✓ — — PA
NC Medicaid Preferred Drug List 2026
via pyquvi 		Non-Preferred ✓ — — PA
NC Medicaid Preferred Drug List 2026 Non-Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Jaythari 		Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - HDHP 2026
via Kymbee 		Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 80/20 Plus PPO 2026 Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026 Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - HDHP 2026 Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 80/20 Plus PPO 2026
via pyquvi 		Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - HDHP 2026
via Jaythari 		Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - HDHP 2026
via pyquvi 		Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026
via Jaythari 		Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026
via pyquvi 		Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 80/20 Plus PPO 2026
via Kymbee 		Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026
via Kymbee 		Tier 4 - Specialty Generic ✓ — — PA
Something not right?