Gammagard ERC
Generic: immunoglobulin G, human
10000 MG
Also known as:
immunoglobulin G, human
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)
58 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Clear Silver with $0 Insulin Options
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Expanded Bronze
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Silver
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Gold
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Focused Silver with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Complete Gold with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Expanded Bronze with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Silver with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Gold with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Complete Gold + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Expanded Bronze + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Silver + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Gold + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Clear Silver with $0 Insulin Options
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold
via Gamunex |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
AmeriHealth Caritas NC
100 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Gamastan |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Gamastan |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Gamastan |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Gamastan |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Gamastan |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Gamastan |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Gamastan |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Gamastan |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Gamastan |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Gamastan |
Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
14 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via Gammaked |
Tier 2 - Preferred Brand | ✓ | — | — | PA |
|
BCBS Federal Focus 2026
via Gammaplex |
Tier 2 - Preferred Brand | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Privigen |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Octagam |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Gammaplex |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Gammaked |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Gammaked |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Gamastan |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Bivigam |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Octagam |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Gammaplex |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Gamastan |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Bivigam |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Privigen |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Medicare Part D
307 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Privigen |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Privigen |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Privigen |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Privigen |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Privigen |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Gammagard |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Gammagard |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
PruittHealth Premier (HMO I-SNP)
via Privigen |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
PruittHealth Premier (HMO I-SNP)
via Gammagard |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
NHC Advantage (HMO I-SNP)
via Privigen |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
NHC Advantage (HMO I-SNP)
via Gammagard |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Bivigam |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Bivigam |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Bivigam |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Troy Medicare (HMO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring True Choice (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring True Choice (PPO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring True Choice (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring True Choice (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring TotalCare (HMO D-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring TotalCare (HMO D-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring TotalCare (HMO D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring TotalCare (HMO D-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Select (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Savings (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Plus (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred (HMO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Select (HMO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Savings (HMO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Plus (HMO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred (HMO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Select (HMO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Savings (HMO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Plus (HMO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 008 NC (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CHOICE 001 NC (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CHOICE 003 NC (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CHOICE 005 NC (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CHOICE 008 NC (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 001 NC (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 003 NC (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 005 NC (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 008 NC (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 001 NC (PPO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 003 NC (PPO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 005 NC (PPO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 008 NC (PPO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 001 NC (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 003 NC (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 005 NC (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 008 NC (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 001 NC (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 003 NC (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 005 NC (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 008 NC (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 001 NC (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 003 NC (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 005 NC (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 008 NC (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Liberty Medicare Advantage (HMO C-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
|
Liberty Medicare Advantage (HMO C-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Blue Medicare PPO Enhanced (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Blue Medicare Essential Plus (HMO-POS)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Blue Medicare Enhanced (HMO-POS)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Blue Medicare Choice (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Blue Medicare Essential (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Experience Health Medicare Advantage (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare PPO Enhanced (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Essential Plus (HMO-POS) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Enhanced (HMO-POS) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Choice (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Essential (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Experience Health Medicare Advantage (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health Platinum (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health smartHMO (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health Platinum Select (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health AVA (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Platinum (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health smartHMO (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Platinum Select (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health AVA (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthTeam Advantage Plan I (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthTeam Advantage Plan II (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthTeam Advantage Vitality Plan (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthTeam Advantage Plan I (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthTeam Advantage Plan II (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthTeam Advantage Vitality Plan (PPO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
| Troy Medicare (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare (HMO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare (HMO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Senior Care (HMO I-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
| Senior Care (HMO I-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
|
Senior Care (HMO I-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Erickson Advantage Signature (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Erickson Advantage Freedom (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Erickson Advantage Liberty (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (HMO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Dual (HMO D-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (HMO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Value Plus (HMO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Prime (HMO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature Care (HMO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (HMO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature Extra (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature Giveback (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Dual (HMO D-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Value Plus (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Prime (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature Care (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature Extra (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature Giveback (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Select (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Savings (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthSpring Preferred Plus (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CORE 001 NC (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CORE 001 NC (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CORE 001 NC (HMO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Privigen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CORE 001 NC (HMO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Gammaplex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CORE 001 NC (HMO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CORE 001 NC (HMO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Bivigam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CORE 001 NC (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 001 NC (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 003 NC (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 005 NC (PPO)
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
NC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via Gammaked |
Tier 5 - Preferred Brand Specialty | ✓ | — | — | PA |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Gammaked |
Tier 5 - Preferred Brand Specialty | ✓ | — | — | PA |
|
NC State Health Plan - HDHP 2026
via Gammaked |
Tier 5 - Preferred Brand Specialty | ✓ | — | — | PA |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Bivigam |
Medical Benefit | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Bivigam |
Medical Benefit | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Bivigam |
Medical Benefit | — | — | — | None |
Oscar Health
168 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AIAN Cost Share | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700 | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Diabetes | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share | with Atrium Health
via Flebogamma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700 | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Diabetes | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share | with Atrium Health
via Gamunex |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700 | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Diabetes | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share | with Atrium Health
via Gammagard |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700 | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Diabetes | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700 | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard | with Atrium Health
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus
via Hyqvia 10 G / 100 ML Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700 | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Diabetes | with Atrium Health
via Octagam |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Diabetes | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share
via Gammaked |
Tier 5 - Specialty | ✓ | — | — | PA |