Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
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
via Emend |
Tier 3 - High Cost Brand | — | — | — | None |
|
BCBSNC Blue Value 2026
via Emend |
Tier 3 - High Cost Brand | — | — | — | None |
|
BCBSNC Blue Care 2026
via Emend |
Tier 3 - High Cost Brand | — | — | — | None |
|
BCBSNC Blue Local 2026
via Emend |
Tier 3 - High Cost Brand | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Emend |
Tier 3 - High Cost Brand | — | — | — | None |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Bronze RD 5000 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Silver
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 2200 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold 1500 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Bronze
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 5500 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3500 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 3500 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 4400 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 5000 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3000 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 6500 Indiv Med Deductible
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver CMS Standard
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD CMS Standard
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold CMS Standard
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD CMS Standard
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold RD CMS Standard
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze CMS Standard
via Emend |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
Medicare Part D
21 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Aetna Medicare Value Plus (HMO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Signature (HMO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Signature (HMO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Dual (HMO D-SNP)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (PPO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Signature Giveback (PPO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Signature Extra (PPO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Signature Care (HMO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Prime (HMO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Troy Medicare (HMO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (PPO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (HMO)
via Emend |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
NC Medicaid PDL
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC Medicaid Preferred Drug List 2026
via Emend |
Non-Preferred | — | — | — | None |
| NC Medicaid Preferred Drug List 2026 | Non-Preferred | — | — | — | None |
|
NC Medicaid Preferred Drug List 2026
via fosaprepitant |
Non-Preferred | — | — | — | None |