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| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Complete Gold | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Everyday Bronze | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Elite Bronze | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Expanded Bronze | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Silver | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Gold | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Elite Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Focused Silver with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Complete Gold with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Silver with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Gold with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Complete Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Elite Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Silver + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | ✓ | QL |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 4 - Higher Cost Brand | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Value 2026 | Tier 4 - Higher Cost Brand | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Care 2026 | Tier 4 - Higher Cost Brand | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Local 2026 | Tier 4 - Higher Cost Brand | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Advantage 2026 | Tier 4 - Higher Cost Brand | ✓ | — | — Restricted Access | PA |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect myDiabetesCare Bronze | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect myDiabetesCare Silver | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Gold 1500 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Bronze 5500 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Silver 3500 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Silver 4400 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Silver 3000 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Bronze 6500 Indiv Med Deductible | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Silver CMS Standard | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Silver RD CMS Standard | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Gold CMS Standard | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Bronze RD CMS Standard | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Gold RD CMS Standard | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Connect Bronze CMS Standard | Tier 4 - Non-Preferred | ✓ | — | — | PA |
Medicare Part D
18 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Aetna Medicare Value Plus (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature Giveback (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature Extra (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Dual (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Enhanced (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature Care (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Prime (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
NC Medicaid PDL
1 planOscar Health
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Silver Simple Diabetes | with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Silver Classic | with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Silver Simple PCP Saver | with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Gold Elite Saver Plus | with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Bronze Classic Standard | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Silver Classic Standard | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Gold Classic Standard | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Bronze Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Silver Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Gold Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Silver Classic | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Secure | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Bronze Classic 4700 | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Silver Simple PCP Saver | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Gold Elite Saver Plus | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Silver Simple Diabetes | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Secure | with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Bronze Classic 4700 | with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 4 - Non-Preferred | — | — | ✓ | QL |