Dexilant

Generic: dexlansoprazole

Capsule

Proton Pump Inhibitors

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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: 23 hours, 45 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Silver + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Gold + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Complete Gold
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Clear Silver with $0 Insulin Options
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Silver
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Gold
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Everyday Bronze with Atrium Health
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Elite Bronze with Atrium Health
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Focused Silver with Atrium Health
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Complete Gold with Atrium Health
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Expanded Bronze with Atrium Health
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Silver with Atrium Health
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Standard Gold with Atrium Health
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Complete Gold + Vision + Adult Dental
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 23 hours, 45 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026 Tier 2 - Medium Cost Generic/Brand — — — Restricted Access None
BCBSNC Blue Advantage 2026 Tier 2 - Medium Cost Generic/Brand — — — Restricted Access None
BCBSNC Blue Care 2026 Tier 2 - Medium Cost Generic/Brand — — — Restricted Access None
BCBSNC Blue Value 2026 Tier 2 - Medium Cost Generic/Brand — — — Restricted Access None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 2 - Medium Cost Generic/Brand — — — Restricted Access None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 23 hours, 45 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026
via dexlansoprazole 		Tier 3 - Non-Preferred — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 23 hours, 45 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Wellcare Giveback Open (PPO)
via dexlansoprazole 		Tier 2 - Generic — — ✓ 30 per 30 days QL
Wellcare Simple (HMO-POS)
via dexlansoprazole 		Tier 2 - Generic — — ✓ 30 per 30 days QL
Wellcare Simple Open (PPO)
via dexlansoprazole 		Tier 2 - Generic — — ✓ 30 per 30 days QL
Aetna Medicare Signature Care (HMO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Enhanced (HMO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Enhanced (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Enhanced (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature Extra (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature Giveback (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Alignment Health Platinum (HMO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Alignment Health Platinum Select (HMO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Alignment Health AVA (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Liberty Open (PPO D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Assist Open (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Access (HMO-POS D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Liberty (HMO-POS D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Alignment Health smartHMO (HMO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Dual Complete NC-S001 (PPO D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Dual Complete NC-S2 (PPO D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0001 (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0004 (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0016 (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0017 (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0019 (PPO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Erickson Advantage Signature (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Erickson Advantage Guardian (HMO-POS I-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Erickson Advantage Freedom (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Erickson Advantage Liberty (HMO-POS)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Complete Care NC-25 (HMO-POS C-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Complete Care NC-27 (HMO-POS C-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
UHC Complete Care NC-28 (HMO-POS C-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Erickson Advantage Champion (HMO-POS C-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (HMO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Dual (HMO D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Signature (HMO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Value Plus (HMO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Aetna Medicare Prime (HMO)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Reserve (HMO-POS D-SNP)
via dexlansoprazole 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 23 hours, 45 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — ✓ — ST
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 23 hours, 45 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via dexlansoprazole 		Tier 3 - Non-Formulary ✓ — — PA
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