diphenhydramine hydrochloride

2.5 MG — Capsule

Histamine-1 Receptor Antagonist

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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: 22 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Elite Bronze with Atrium Health
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Complete Gold Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 2 - Generic — — ✓ QL
Everyday Bronze Tier 2 - Generic — — ✓ QL
Elite Bronze Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Complete Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Elite Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Silver + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Complete Gold
via Benadryl 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Benadryl 		Tier 2 - Generic — — ✓ QL
Everyday Bronze
via Benadryl 		Tier 2 - Generic — — ✓ QL
Elite Bronze
via Benadryl 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Silver + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Gold + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Complete Gold + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Elite Bronze + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Silver + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Gold + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze Tier 2 - Generic — — ✓ QL
Standard Silver Tier 2 - Generic — — ✓ QL
Standard Gold Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Silver
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Gold
via Benadryl 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health
via Benadryl 		Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health
via Benadryl 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health
via Benadryl 		Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health
via Benadryl 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health
via Benadryl 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Complete Gold + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Elite Bronze + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Benadryl 		Tier 2 - Generic — — ✓ QL
Complete Gold
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Everyday Bronze
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Elite Bronze
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Silver
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
Standard Gold
via Wal-Dryl Childrens 		Tier 2 - Generic — — ✓ QL
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