famciclovir

125 mg, 250 mg, 500 mg — Tablet

Also known as: famciclovir oral Famvir famciclovir tabs 125mg, 250mg, 500mg famciclovir tab 125 mg, 250 mg, 500 mg Famciclovir 125 Mg Tablet Famciclovir 250 Mg Tablet Famciclovir 500 Mg Tablet Famciclovir Oral Tablet

Compare Prices

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

Ambetter (Centene)

34 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 15 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Complete Gold with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options	Tier 2 - Generic	—	—	✓	QL
Signature Expanded Bronze	Tier 2 - Generic	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Signature Silver	Tier 2 - Generic	—	—	✓	QL
Signature Gold	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Signature Expanded Bronze with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Signature Silver with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Signature Gold with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Complete Gold + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Elite Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Complete Gold	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze	Tier 2 - Generic	—	—	✓	QL
Elite Bronze	Tier 2 - Generic	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Streamlined Silver	Tier 2 - Generic	—	—	✓	QL
Streamlined Silver with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options	Tier 2 - Generic	—	—	✓	QL
Signature Silver + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Signature Gold + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL

AmeriHealth Caritas NC

11 plans

Source: CMS QHP JSON · Formulary date: Sep 22, 2026 · Checked: 15 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	—	None

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 15 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026	Tier 1 - Generic	—	—	—	None
BCBS Federal Basic Option 2026	Tier 1 - Generic	—	—	—	None
BCBS Federal Standard Option 2026	Tier 1 - Generic	—	—	—	None

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 15 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Value 2026	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Advantage 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

Cigna

20 plans

Source: PDF · Formulary date: Oct 7, 2026 · Checked: 15 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Gold RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver 3600 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze	Tier 2 - Generic	—	—	—	None
Connect Silver 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None

Medicare Part D

140 plans

Source: CMS QHP JSON · Formulary date: Sep 16, 2026 · Checked: 15 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NHC Advantage (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	✓ 90 per 30 days	QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Community Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
PruittHealth Premier (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	✓ 90 per 30 days	QL
Liberty Medicare Dual Plan (HMO D-SNP)	Tier 1 - Preferred Generic	—	—	✓ 90 per 30 days	QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	✓ 90 per 30 days	QL
Provider Partners North Carolina Essential Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
Longevity Health Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
Wellcare Dual Reserve (HMO-POS D-SNP)	Tier 2 - Generic	—	—	—	None
Wellcare Simple Open (PPO)	Tier 2 - Generic	—	—	—	None
Wellcare Dual Liberty Open (PPO D-SNP)	Tier 2 - Generic	—	—	—	None
Wellcare Assist Open (PPO)	Tier 2 - Generic	—	—	—	None
Wellcare Giveback Open (PPO)	Tier 2 - Generic	—	—	—	None
Aetna Medicare Signature (HMO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Dual (HMO D-SNP)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Signature (HMO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Value Plus (HMO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Prime (HMO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Signature Care (HMO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Full Dual Care (HMO D-SNP)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Chronic Care (HMO C-SNP)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Enhanced (HMO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Chronic Care Value (HMO C-SNP)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Wellcare Simple (HMO-POS)	Tier 2 - Generic	—	—	—	None
Wellcare Dual Access (HMO-POS D-SNP)	Tier 2 - Generic	—	—	—	None
Wellcare Dual Liberty (HMO-POS D-SNP)	Tier 2 - Generic	—	—	—	None
Senior Care (HMO I-SNP)	Tier 2 - Generic	—	—	✓ 90 per 30 days	QL
Troy Medicare (HMO)	Tier 2 - Generic	—	—	—	None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 2 - Generic	—	—	—	None
Alignment Health NC Duals (HMO-POS D-SNP)	Tier 2 - Generic	—	—	—	None
Alignment Health smartHMO (HMO)	Tier 2 - Generic	—	—	—	None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)	Tier 2 - Generic	—	—	—	None
Alignment Health Platinum Select (HMO)	Tier 2 - Generic	—	—	—	None
Alignment Health Heart & Diabetes Care (HMO C-SNP)	Tier 2 - Generic	—	—	—	None
Aetna Medicare Signature (PPO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Enhanced (PPO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Enhanced (PPO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Signature Extra (PPO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Signature (PPO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Signature (PPO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Signature Giveback (PPO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Aetna Medicare Signature (PPO)	Tier 2 - Generic	—	—	✓ 21 per 30 days	QL
Liberty Medicare Advantage (HMO C-SNP)	Tier 2 - Generic	—	—	✓ 90 per 30 days	QL
Alignment Health AVA (PPO)	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 2 - Generic	—	—	—	None
Alignment Health Platinum (HMO)	Tier 2 - Generic	—	—	—	None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED CHOICE 003 NC (PPO)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED CHOICE GIVEBACK 004 NC (PPO)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED CHOICE 005 NC (PPO)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED CHOICE GIVEBACK 006 NC (PPO)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED CHOICE 008 NC (PPO)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
UHC Complete Care NC-25 (HMO-POS C-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
UHC Complete Care NC-27 (HMO-POS C-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
UHC Complete Care NC-28 (HMO-POS C-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-S2 (PPO D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HealthSpring Preferred (HMO)	Tier 3 - Preferred Brand	—	—	✓ 60 per 30 days	QL
HealthSpring TotalCare Plus (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 60 per 30 days	QL
HealthSpring Preferred Select (HMO)	Tier 3 - Preferred Brand	—	—	✓ 60 per 30 days	QL
HealthSpring Preferred Savings (HMO)	Tier 3 - Preferred Brand	—	—	✓ 60 per 30 days	QL
HealthSpring Preferred Plus (HMO)	Tier 3 - Preferred Brand	—	—	✓ 60 per 30 days	QL
HealthTeam Advantage Plan I (PPO)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HealthSpring TotalCare (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 60 per 30 days	QL
HealthTeam Advantage Plan II (PPO)	Tier 3 - Preferred Brand	—	—	—	None
HealthTeam Advantage Vitality Plan (PPO)	Tier 3 - Preferred Brand	—	—	—	None
Humana Gold Plus H1036-137 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Gold Plus H1036-335 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
UHC Dual Complete NC-S001 (PPO D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Blue Medicare Essential (HMO)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Choice (HMO)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Enhanced (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Essential Plus (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare PPO Enhanced (PPO)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0019 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HumanaChoice Giveback H5216-017 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HumanaChoice H5216-211 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Gold Plus H1036-233 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Dual Select H1036-307 (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-0017 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Gold Plus Giveback H1036-318 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Experience Health Medicare Advantage (HMO)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED CHOICE GIVEBACK 009 NC (PPO)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED CORE 001 NC (HMO)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED GIVEBACK 002 NC (HMO)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED DUAL 009 NC (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED GIVEBACK 012 NC (HMO)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED DUAL FULL 013 NC (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0016 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Full Access H5525-034 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HumanaChoice Giveback H5525-035 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HumanaChoice H5525-049 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HumanaChoice H5525-050 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HumanaChoice H5525-070 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Dual Select H5525-072 (PPO D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HumanaChoice H5525-083 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Erickson Advantage Signature (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Erickson Advantage Guardian (HMO-POS I-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Erickson Advantage Champion (HMO-POS C-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Erickson Advantage Freedom (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Erickson Advantage Liberty (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-0004 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
AARP Medicare Advantage from UHC NC-0001 (PPO)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Gold Plus H6622-025 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Gold Plus H6622-026 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Dual Select H6622-027 (HMO-POS D-SNP)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Gold Plus H6622-057 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Gold Plus H6622-060 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Humana Gold Plus H6622-061 (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
HealthSpring True Choice (PPO)	Tier 3 - Preferred Brand	—	—	✓ 60 per 30 days	QL
Humana Gold Choice H8145-004 (PFFS)	Tier 3 - Preferred Brand	—	—	✓ 90 per 30 days	QL
Healthy Blue + Medicare (HMO-POS D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
DEVOTED CHOICE 001 NC (PPO)	Tier 3 - Preferred Brand	—	—	—	None

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 15 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Preferred	✓	—	—	PA

NC State Health Plan

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 15 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	—	—	—	None

Oscar Health

28 plans

Source: CMS QHP JSON · Checked: 15 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Silver Classic	Tier 2 - Generic	—	—	—	None
Gold Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health	Tier 2 - Generic	—	—	—	None
AIAN Cost Share	Tier 2 - Generic	—	—	—	None
AIAN Cost Share \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Classic \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Gold Elite Saver Plus \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Secure	Tier 2 - Generic	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Secure \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Classic Standard	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes	Tier 2 - Generic	—	—	—	None
Gold Elite Saver Plus	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver	Tier 2 - Generic	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus	Tier 2 - Generic	—	—	—	None
Gold Classic Standard	Tier 2 - Generic	—	—	—	None

UnitedHealthcare

17 plans

Source: PDF · Formulary date: Sep 23, 2026 · Checked: 15 hours, 24 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None