Estratest
Generic: estrogens, esterified (USP)
0.625 MG — Tablet
Also known as:
estrogens, esterified (USP)
Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Ambetter (Centene)
116 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Complete Gold
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Focused Silver with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver with Atrium Health
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold with Atrium Health
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze with Atrium Health
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze with Atrium Health
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Focused Silver with Atrium Health
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold with Atrium Health
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver with Atrium Health
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold with Atrium Health
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze | Tier 4 - Non-Preferred | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Focused Silver with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze with Atrium Health
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze with Atrium Health
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Focused Silver with Atrium Health
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold with Atrium Health
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze 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 Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via estrogens, esterified (USP) |
Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold | Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze
via Covaryx |
Tier 4 - Non-Preferred | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Covaryx |
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 Menest |
Tier 4 - Non-Preferred | — | ✓ | — | ST |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Menest |
Tier 4 - Non-Preferred | — | ✓ | — | ST |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Menest |
Tier 4 - Non-Preferred | — | ✓ | — | ST |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Menest |
Tier 4 - Non-Preferred | — | ✓ | — | ST |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Menest |
Tier 4 - Non-Preferred | — | ✓ | — | ST |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Menest |
Tier 4 - Non-Preferred | — | ✓ | — | ST |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Menest |
Tier 4 - Non-Preferred | — | ✓ | — | ST |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Menest |
Tier 4 - Non-Preferred | — | ✓ | — | ST |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Menest |
Tier 4 - Non-Preferred | — | ✓ | — | ST |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Menest |
Tier 4 - Non-Preferred | — | ✓ | — | ST |
Blue Cross Blue Shield Federal
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Covaryx |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Covaryx |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Cigna
40 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Silver RD 2200 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold 1500 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Bronze
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 5500 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3500 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze CMS Standard
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold RD CMS Standard
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD CMS Standard
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold CMS Standard
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD CMS Standard
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver CMS Standard
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 5000 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 3500 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 4400 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 6500 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 5000 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3000 Indiv Med Deductible
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Silver
via Covaryx |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze CMS Standard
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect myDiabetesCare Silver
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Silver RD 2200 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Gold 1500 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect myDiabetesCare Bronze
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Bronze 5500 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Silver 3500 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Bronze RD 5000 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Silver RD 3500 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Silver 4400 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Silver RD 5000 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Silver 3000 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Bronze 6500 Indiv Med Deductible
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Silver CMS Standard
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Silver RD CMS Standard
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Gold CMS Standard
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Bronze RD CMS Standard
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Connect Gold RD CMS Standard
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
NC Medicaid PDL
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via Menest |
Not Covered | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Menest |
Not Covered | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Menest |
Not Covered | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Bronze Classic Standard
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Classic Standard
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Gold Classic Standard
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Classic Standard | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Classic Standard | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Gold Classic Standard | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Elite + PCP Saver Plus
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Classic
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Secure
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
AIAN Cost Share | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
AIAN Cost Share
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Simple Diabetes | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Gold Elite Saver Plus | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Classic 4700
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple PCP Saver | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple Diabetes | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Classic | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Secure | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Classic 4700 | with Atrium Health
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple Diabetes
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Gold Elite Saver Plus
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple PCP Saver
via Menest |
Tier 4 - Non-Preferred | — | — | — | None |