diltiazem hcl
Generic: diltiazem hcl er beads
120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg — Capsule
Also known as:
diltiazem hcl er beads
diltiazem hcl er coated beads
diltiazem hcl er oral capsule
diltiazem hcl oral
diltiazem hcl soln 25mg/5ml, 50mg/10ml, 125mg/25ml
diltiazem hcl cap er 12hr 60 mg, 90 mg, 120 mg
diltiazem hcl cap er 24hr 120 mg, 180 mg, 240 mg
diltiazem hcl tab 30 mg, 60 mg, 120 mg
diltiazem hcl tab 90 mg
TIADYLT ER
TIAZAC
DILTIAZEM 24HR ER
TAZTIA XT
diltiazem hcl soln 25mg/5ml, 50mg/10ml,
dilTIAZem HCl ER Beads Oral Capsule Extended Release
dilTIAZem HCl ER Oral Capsule Extended Release
dilTIAZem HCl Oral Tablet
dilTIAZem HCl ER Coated Beads Oral Capsule Extended Release
Compare Prices
Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via diltiazem hcl extended release beads cp24 |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Standard Option 2026
via diltiazem hcl extended release beads cp24 |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via diltiazem hcl extended release beads cp24 |
Tier 1 - Generic | — | — | — | None |
Blue Cross Blue Shield of NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Value 2026
via Tiazac |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Local 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Tiazac |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Care 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Tiazac |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Local 2026
via Tiazac |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Advantage 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Care 2026
via Tiazac |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Value 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Silver RD 3500 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 6500 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 5500 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 5000 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3600 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3000 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze CMS Standard
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver CMS Standard
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold CMS Standard
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Bronze
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Silver
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold 1500 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 5000 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 6000 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD CMS Standard
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 5000 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD CMS Standard
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 2200 Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold RD CMS Standard
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
Medicare Part D
277 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
PruittHealth Premier (HMO I-SNP)
via tiadylt er |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via tiadylt er |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via tiadylt er |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via tiadylt er |
Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via tiadylt er |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via tiadylt er |
Tier 1 - Preferred Generic | — | — | — | None |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via tiadylt er |
Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via tiadylt er |
Tier 1 - Preferred Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via tiadylt er |
Tier 1 - Preferred Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via tiadylt er |
Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health Platinum (HMO) | Tier 2 - Generic | — | — | — | None |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Alignment Health smartHMO (HMO) | Tier 2 - Generic | — | — | — | None |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 2 - Generic | — | — | — | None |
| Alignment Health Platinum Select (HMO) | Tier 2 - Generic | — | — | — | None |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CORE 001 NC (HMO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature Extra (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature Giveback (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | — | None |
| Humana Full Access H5525-034 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-049 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-050 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-070 (PPO) | Tier 2 - Generic | — | — | — | None |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-083 (PPO) | Tier 2 - Generic | — | — | — | None |
| Erickson Advantage Signature (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 2 - Generic | — | — | — | None |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 2 - Generic | — | — | — | None |
| Erickson Advantage Freedom (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Erickson Advantage Liberty (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 2 - Generic | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Choice H8145-004 (PFFS) | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE 001 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE 003 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE 005 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE 008 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| HealthSpring TotalCare (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| HealthSpring Preferred (HMO) | Tier 2 - Generic | — | — | — | None |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| HealthSpring Preferred Select (HMO) | Tier 2 - Generic | — | — | — | None |
| HealthSpring Preferred Savings (HMO) | Tier 2 - Generic | — | — | — | None |
| HealthSpring Preferred Plus (HMO) | Tier 2 - Generic | — | — | — | None |
| HealthTeam Advantage Plan I (PPO) | Tier 2 - Generic | — | — | — | None |
| HealthTeam Advantage Plan II (PPO) | Tier 2 - Generic | — | — | — | None |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 2 - Generic | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Blue Medicare Choice (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Blue Medicare Essential (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via tiadylt er |
Tier 2 - Generic | — | — | — | None |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H1036-137 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Assist Open (PPO) | Tier 2 - Generic | — | — | — | None |
| Wellcare Giveback Open (PPO) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Value Plus (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Prime (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature Care (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Enhanced (HMO) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare PPO Enhanced (PPO) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare Essential Plus (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare Enhanced (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare Choice (HMO) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare Essential (HMO) | Tier 2 - Generic | — | — | — | None |
| Experience Health Medicare Advantage (HMO) | Tier 2 - Generic | — | — | — | None |
| Wellcare Simple (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Senior Care (HMO I-SNP) | Tier 2 - Generic | — | — | — | None |
| Troy Medicare (HMO) | Tier 2 - Generic | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5216-211 (PPO) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 2 - Generic | — | — | — | None |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 2 - Generic | — | — | — | None |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via tiadylt er |
Tier 6 - Specialty Plus | — | — | — | None |
NC State Health Plan
9 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 70/30 Standard PPO 2026
via diltiazem hcl extended release beads cp24 |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via diltiazem hcl extended release beads cp24 |
Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via diltiazem hcl extended release beads cp24 |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via diltiazem hcl tb24 |
Not Covered | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via diltiazem hcl tb24 |
Not Covered | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via diltiazem hcl tb24 |
Not Covered | — | — | — | None |