dexlansoprazole

30 mg, 60 mg — Delayed Release Capsule

Also known as: dexlansoprazole cap delayed release 30 mg, 60 mg Dexlansoprazole Dr 30 Mg Capsule Dexlansoprazole Dr 60 Mg Capsule DEXILANT DEXLANSOPRAZOLE DR Dexlansoprazole Oral Capsule Delayed Release

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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)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 14 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Gold with Atrium Health	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Silver with Atrium Health	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Expanded Bronze with Atrium Health	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold with Atrium Health	Tier 4 - Non-Preferred	—	—	✓	QL
Focused Silver with Atrium Health	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze with Atrium Health	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze with Atrium Health	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Gold	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Silver	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Expanded Bronze	Tier 4 - Non-Preferred	—	—	✓	QL
Clear Silver with $0 Insulin Options	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Gold + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Silver + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	—	—	✓	QL

AmeriHealth Caritas NC

10 plans

Source: CMS QHP JSON · Checked: 14 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Essential + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Silver Signature + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Bronze Signature + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Gold Premier + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Bronze Premier + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Gold Signature + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Bronze Essential + No Referrals	Tier 2 - Generic	✓	—	—	PA

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 14 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Care 2026 via Dexilant	Tier 2 - Medium Cost Generic/Brand	—	—	— Restricted Access	None
BCBSNC Blue Local 2026 via Dexilant	Tier 2 - Medium Cost Generic/Brand	—	—	— Restricted Access	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Dexilant	Tier 2 - Medium Cost Generic/Brand	—	—	— Restricted Access	None
BCBSNC Blue Value 2026 via Dexilant	Tier 2 - Medium Cost Generic/Brand	—	—	— Restricted Access	None
BCBSNC Blue Advantage 2026 via Dexilant	Tier 2 - Medium Cost Generic/Brand	—	—	— Restricted Access	None

Cigna

20 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 14 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Bronze RD 5000 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Silver 3500 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Bronze RD 6000 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Bronze 5500 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect myDiabetesCare Bronze via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Gold 1500 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Silver RD 2200 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect myDiabetesCare Silver via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Silver CMS Standard via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Bronze CMS Standard via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Gold RD CMS Standard via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Bronze RD CMS Standard via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Gold CMS Standard via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Silver 3000 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Silver 4400 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Bronze 7000 HSA Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Silver RD 3500 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Silver RD CMS Standard via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Bronze 6500 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL
Connect Silver RD 5000 Indiv Med Deductible via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓	QL

Medicare Part D

130 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 14 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Wellcare Simple (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 2 - Generic	—	—	✓ 30 per 30 days	QL
Wellcare Simple Open (PPO) via DEXLANSOPRAZOLE DR	Tier 2 - Generic	—	—	✓ 30 per 30 days	QL
Wellcare Simple (HMO-POS)	Tier 2 - Generic	—	—	✓ 30 per 30 days	QL
Wellcare Simple Open (PPO)	Tier 2 - Generic	—	—	✓ 30 per 30 days	QL
Wellcare Giveback Open (PPO) via DEXLANSOPRAZOLE DR	Tier 2 - Generic	—	—	✓ 30 per 30 days	QL
Wellcare Giveback Open (PPO)	Tier 2 - Generic	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature Care (HMO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Full Dual Care (HMO D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Enhanced (HMO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Enhanced (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Enhanced (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature Extra (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature Giveback (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (HMO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Dual (HMO D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (HMO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Value Plus (HMO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Prime (HMO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature Care (HMO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Full Dual Care (HMO D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Enhanced (HMO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Enhanced (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Enhanced (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature Extra (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature Giveback (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Chronic Care (HMO C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Chronic Care Value (HMO C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Chronic Care (HMO C-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Chronic Care Value (HMO C-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health Platinum (HMO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health NC Duals (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health smartHMO (HMO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health Platinum Select (HMO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health AVA (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health Platinum (HMO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health NC Duals (HMO-POS D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health smartHMO (HMO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health AVA (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Wellcare Dual Liberty Open (PPO D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Wellcare Assist Open (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Wellcare Dual Access (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Wellcare Dual Liberty (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Wellcare Dual Liberty Open (PPO D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Wellcare Assist Open (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Wellcare Dual Access (HMO-POS D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Wellcare Dual Liberty (HMO-POS D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Wellcare Dual Reserve (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Wellcare Dual Reserve (HMO-POS D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Alignment Health Platinum Select (HMO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-S001 (PPO D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-S2 (PPO D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0001 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0004 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0016 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0017 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0019 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Signature (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Guardian (HMO-POS I-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Freedom (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Liberty (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-S001 (PPO D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-S2 (PPO D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0001 (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0004 (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0016 (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0017 (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0019 (PPO) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Signature (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Guardian (HMO-POS I-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Freedom (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Liberty (HMO-POS) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Complete Care NC-25 (HMO-POS C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Complete Care NC-27 (HMO-POS C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Complete Care NC-28 (HMO-POS C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Champion (HMO-POS C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Complete Care NC-25 (HMO-POS C-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Complete Care NC-27 (HMO-POS C-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Complete Care NC-28 (HMO-POS C-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Champion (HMO-POS C-SNP) via DEXLANSOPRAZOLE DR	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (HMO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Dual (HMO D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (HMO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Value Plus (HMO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Prime (HMO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 14 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Dexilant	Non-Preferred	—	✓	—	ST

Oscar Health

28 plans

Source: CMS QHP JSON · Checked: 14 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Bronze Elite + PCP Saver Plus \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Classic \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Simple Diabetes \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Simple PCP Saver \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Gold Elite Saver Plus \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Bronze Simple Diabetes \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Simple Chronic Care CKM \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
AIAN Cost Share	Tier 2 - Generic	✓	—	✓	PA \| QL
AIAN Cost Share \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Secure \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Bronze Classic 4700 \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Gold Elite Saver Plus	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Simple PCP Saver	Tier 2 - Generic	✓	—	✓	PA \| QL
Bronze Classic 4700	Tier 2 - Generic	✓	—	✓	PA \| QL
Secure	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Classic	Tier 2 - Generic	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus	Tier 2 - Generic	✓	—	✓	PA \| QL
Gold Classic Standard \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Classic Standard \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Bronze Classic Standard \| with Atrium Health	Tier 2 - Generic	✓	—	✓	PA \| QL
Gold Classic Standard	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Classic Standard	Tier 2 - Generic	✓	—	✓	PA \| QL
Bronze Classic Standard	Tier 2 - Generic	✓	—	✓	PA \| QL
Silver Simple Diabetes	Tier 2 - Generic	✓	—	✓	PA \| QL

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jun 24, 2026 · Checked: 14 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA