granisetron

Generic: Sancuso

3.1 mg/24 hour — Tablet

ANTIEMETIC-ANTIVERTIGO AGENTS

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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 14 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Silver Tier 2 - Generic — — ✓ QL
Standard 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
Complete Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Elite Bronze Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze Tier 2 - Generic — — ✓ QL
Complete Gold Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 2 - Generic — — ✓ QL
Everyday Bronze 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
Standard Expanded Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Silver + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Checked: 14 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 2 - Generic — — ✓ QL
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 2 - Generic — — ✓ QL
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 2 - Generic — — ✓ QL
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 2 - Generic — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 2 - Generic — — ✓ QL
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 2 - Generic — — ✓ QL
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 2 - Generic — — ✓ QL
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 2 - Generic — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 2 - Generic — — ✓ QL
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 2 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 14 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
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-0016 (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-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
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
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 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
UHC Complete Care NC-25 (HMO-POS C-SNP)
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 Champion (HMO-POS C-SNP)
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 TotalCare Plus (HMO D-SNP)
via Sancuso 		Tier 5 - Specialty — — — None
HealthSpring Preferred (HMO)
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
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 14 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Sancuso 		Non-Preferred — — — None
Source: CMS QHP JSON  ·  Checked: 14 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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 Elite + PCP Saver Plus Tier 2 - Generic — — ✓ QL
Silver Classic Tier 2 - Generic — — ✓ QL
Secure 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
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
Bronze Classic Standard 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 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
Bronze Simple Diabetes | with Atrium Health Tier 2 - Generic — — ✓ QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — ✓ QL
Silver Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — ✓ QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 2 - Generic — — ✓ QL
AIAN Cost Share Tier 2 - Generic — — ✓ QL
AIAN Cost Share | with Atrium Health Tier 2 - Generic — — ✓ QL
Gold Classic Standard Tier 2 - Generic — — ✓ QL
Silver Classic Standard Tier 2 - Generic — — ✓ QL
Bronze Elite + PCP Saver Plus | with Atrium Health
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 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
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
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 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
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
AIAN Cost Share | with Atrium Health
via Sancuso 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Source: Excel (XLSX)  ·  Formulary date: Jun 24, 2026  ·  Checked: 14 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary — — ✓ QL
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 14 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, 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 Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 3 - Preferred Brand — — ✓ QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 3 - Preferred Brand — — ✓ QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 3 - Preferred Brand — — ✓ QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 3 - Preferred Brand — — ✓ QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 3 - Preferred Brand — — ✓ QL
UHC Bronze Standard (No Referrals) Tier 3 - Preferred Brand — — ✓ QL
UHC Silver Standard (No Referrals) Tier 3 - Preferred Brand — — ✓ QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 3 - Preferred Brand — — ✓ QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 3 - Preferred Brand — — ✓ QL
UHC Gold Standard (No Referrals) Tier 3 - Preferred Brand — — ✓ QL
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 3 - Preferred Brand — — ✓ QL
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