granisetron

Generic: Sancuso

3.1 mg/24 hour — Tablet

Also known as: Granisetron 1 Mg Tablet Granisetron 0.1 Mg/Ml Vial Granisetron 1 Mg/Ml Vial Granisetron 4 Mg/4 Ml Vial SANCUSO

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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: 17 hours, 22 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Focused Silver with Atrium Health	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
Clear Silver with $0 Insulin Options	Tier 2 - Generic	—	—	✓	QL
Signature Expanded Bronze	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
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
Signature Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Complete Gold	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
Complete Gold 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
Signature Expanded Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL

AmeriHealth Caritas NC

11 plans

Source: CMS QHP JSON · Formulary date: Sep 22, 2026 · Checked: 17 hours, 22 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 2 - Generic	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 2 - Generic	—	—	✓	QL
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
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	—	—	✓	QL
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 4 - Non-Preferred	—	—	✓	QL

Medicare Part D

39 plans

Source: CMS QHP JSON · Formulary date: Sep 16, 2026 · Checked: 17 hours, 22 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AARP Medicare Advantage from UHC NC-0016 (PPO) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
UHC Dual Complete NC-S001 (PPO D-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
UHC Dual Complete NC-S2 (PPO D-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0001 (PPO) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0004 (PPO) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0017 (PPO) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0019 (PPO) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
UHC Complete Care NC-25 (HMO-POS C-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
UHC Complete Care NC-27 (HMO-POS C-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
UHC Complete Care NC-28 (HMO-POS C-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
Erickson Advantage Signature (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
Erickson Advantage Guardian (HMO-POS I-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
Erickson Advantage Champion (HMO-POS C-SNP) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
Erickson Advantage Freedom (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
Erickson Advantage Liberty (HMO-POS) via Sancuso	Tier 5 - Specialty	—	—	✓ 4 per 28 days	QL
HealthSpring True Choice (PPO) via Sancuso	Tier 5 - Specialty	—	—	—	None
HealthSpring TotalCare (HMO D-SNP) via Sancuso	Tier 5 - Specialty	—	—	—	None
HealthSpring Preferred (HMO) via Sancuso	Tier 5 - Specialty	—	—	—	None
HealthSpring TotalCare Plus (HMO D-SNP) via Sancuso	Tier 5 - Specialty	—	—	—	None
HealthSpring Preferred Select (HMO) via Sancuso	Tier 5 - Specialty	—	—	—	None
HealthSpring Preferred Savings (HMO) via Sancuso	Tier 5 - Specialty	—	—	—	None
HealthSpring Preferred Plus (HMO) via Sancuso	Tier 5 - Specialty	—	—	—	None

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 17 hours, 22 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Sancuso	Non-Preferred	—	—	—	None

Oscar Health

56 plans

Source: CMS QHP JSON · Checked: 17 hours, 22 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AIAN Cost Share	Tier 2 - Generic	—	—	✓	QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Silver Simple Chronic Care CKM \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Bronze Elite + PCP Saver Plus	Tier 2 - Generic	—	—	✓	QL
Silver Classic	Tier 2 - Generic	—	—	✓	QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Bronze Classic 4700	Tier 2 - Generic	—	—	✓	QL
Silver Simple PCP Saver	Tier 2 - Generic	—	—	✓	QL
Gold Elite Saver Plus	Tier 2 - Generic	—	—	✓	QL
Silver Simple Diabetes	Tier 2 - Generic	—	—	✓	QL
Bronze Classic Standard	Tier 2 - Generic	—	—	✓	QL
Silver Classic Standard	Tier 2 - Generic	—	—	✓	QL
Gold Classic Standard	Tier 2 - Generic	—	—	✓	QL
Bronze Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Silver Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Gold Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Secure \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Bronze Classic 4700 \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Bronze Elite + PCP Saver Plus \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Silver Classic \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Silver Simple Diabetes \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Silver Simple PCP Saver \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Gold Elite Saver Plus \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Bronze Simple Diabetes \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
AIAN Cost Share \| with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Secure	Tier 2 - Generic	—	—	✓	QL
AIAN Cost Share \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Classic \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Simple Diabetes \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Simple PCP Saver \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Gold Elite Saver Plus \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Bronze Simple Diabetes \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Simple Chronic Care CKM \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
AIAN Cost Share via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Classic via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Secure via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Bronze Classic 4700 via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Simple PCP Saver via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Gold Elite Saver Plus via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Simple Diabetes via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Bronze Classic Standard via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Classic Standard via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Gold Classic Standard via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Bronze Classic Standard \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Silver Classic Standard \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Gold Classic Standard \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Bronze Simple Chronic Care CKM \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Secure \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Bronze Classic 4700 \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus \| with Atrium Health via Sancuso	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jul 31, 2026 · Checked: 17 hours, 22 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	✓	QL

UnitedHealthcare

17 plans

Source: PDF · Formulary date: Sep 23, 2026 · Checked: 17 hours, 22 minutes ago

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