Easygel

Generic: stannous fluoride

MOUTH/THROAT/DENTAL AGENTS

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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: 12 hours, 47 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Everyday Bronze
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Elite Bronze
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Clear Silver with $0 Insulin Options
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Silver
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Gold
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Everyday Bronze with Atrium Health
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Elite Bronze with Atrium Health
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Focused Silver with Atrium Health
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Complete Gold with Atrium Health
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze with Atrium Health
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Silver with Atrium Health
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Gold with Atrium Health
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Complete Gold + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Everyday Bronze + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Elite Bronze + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Silver + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Gold + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Silver with Atrium Health + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Signature Gold with Atrium Health + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Enhanced CHF Heart Care Silver $0 Rx Options
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Streamlined Silver with Atrium Health
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Streamlined Silver
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via stannous fluoride 		Tier 0 - $0 Preventive — — — None
Complete Gold
via Perio Med 		Tier 0 - $0 Preventive — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Perio Med 		Tier 0 - $0 Preventive — — — None
Everyday Bronze
via Perio Med 		Tier 0 - $0 Preventive — — — None
Elite Bronze
via Perio Med 		Tier 0 - $0 Preventive — — — None
Clear Silver with $0 Insulin Options
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Silver
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Gold
via Perio Med 		Tier 0 - $0 Preventive — — — None
Everyday Bronze with Atrium Health
via Perio Med 		Tier 0 - $0 Preventive — — — None
Elite Bronze with Atrium Health
via Perio Med 		Tier 0 - $0 Preventive — — — None
Focused Silver with Atrium Health
via Perio Med 		Tier 0 - $0 Preventive — — — None
Complete Gold with Atrium Health
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze with Atrium Health
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Silver with Atrium Health
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Gold with Atrium Health
via Perio Med 		Tier 0 - $0 Preventive — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Complete Gold + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Everyday Bronze + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Elite Bronze + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Silver + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Gold + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Silver with Atrium Health + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Signature Gold with Atrium Health + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Enhanced CHF Heart Care Silver $0 Rx Options
via Perio Med 		Tier 0 - $0 Preventive — — — None
Streamlined Silver with Atrium Health
via Perio Med 		Tier 0 - $0 Preventive — — — None
Streamlined Silver
via Perio Med 		Tier 0 - $0 Preventive — — — None
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Perio Med 		Tier 0 - $0 Preventive — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 12 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Local 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Care 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Value 2026 Tier 4 - Higher Cost Brand — — — None
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