Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 6 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 0 - $0 Preventive None
UHC Gold Standard (No Referrals) Tier 0 - $0 Preventive None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 0 - $0 Preventive None
UHC Silver Standard (No Referrals) Tier 0 - $0 Preventive None
UHC Bronze Standard (No Referrals) Tier 0 - $0 Preventive None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 0 - $0 Preventive None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 0 - $0 Preventive None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 0 - $0 Preventive None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 0 - $0 Preventive None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 0 - $0 Preventive None
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 0 - $0 Preventive None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 0 - $0 Preventive None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 0 - $0 Preventive None
Something not right?