diclofenac

Drops

Also known as: Voltaren Pennsaid

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: 1 hour, 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Standard Gold with Atrium Health + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Complete Gold via Voltaren	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Voltaren	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze via Voltaren	Tier 2 - Generic	—	—	✓	QL
Elite Bronze via Voltaren	Tier 2 - Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Silver via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Gold via Voltaren	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health via Voltaren	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health via Voltaren	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health via Voltaren	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze with Atrium Health via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Silver with Atrium Health via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Gold with Atrium Health via Voltaren	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Complete Gold + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Silver + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Gold + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL
Standard Silver with Atrium Health + Vision + Adult Dental via Voltaren	Tier 2 - Generic	—	—	✓	QL

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 1 hour, 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Preferred	—	—	—	None