E.E.S.
Generic: erythromycin ethylsuccinate
200MG/5ML — Tablet
Also known as:
E.E.S. GRANULES SUSR 200MG/5ML
erythromycin ethylsuccinate
E.E.S. Granules
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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)
58 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Complete Gold + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Focused Silver with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze | Tier 4 - Non-Preferred | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold | Tier 4 - Non-Preferred | — | — | — | None |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Advantage 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Local 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Care 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
| BCBSNC Blue Value 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
Medicare Part D
61 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Troy Medicare (HMO)
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via erythromycin ethylsuccinate |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via erythromycin ethylsuccinate |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via erythromycin ethylsuccinate |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via erythromycin ethylsuccinate |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred (HMO)
via erythromycin ethylsuccinate |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via erythromycin ethylsuccinate |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via erythromycin ethylsuccinate |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CORE 001 NC (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 001 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 003 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 005 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 008 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 70/30 Standard PPO 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Not Covered | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AIAN Cost Share
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
AIAN Cost Share | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Diabetes | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Chronic Care CKM | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Secure
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic 4700
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple PCP Saver
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Gold Elite Saver Plus
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Diabetes
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Secure | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic 4700 | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Diabetes | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple PCP Saver | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Gold Elite Saver Plus | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic Standard
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic Standard
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Gold Classic Standard
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic Standard | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic Standard | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Gold Classic Standard | with Atrium Health
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic
via erythromycin ethylsuccinate |
Tier 2 - Generic | — | — | — | None |
TRICARE
1 planUnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Bronze Standard (No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Gold Standard (No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Silver Standard (No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via erythromycin ethylsuccinate |
Tier 4 - Non-Preferred | — | — | — | None |