Grastek

Generic: Timothy grass pollen extract

Sublingual Tablet

BIOLOGICALS MISC

Also known as: Timothy grass pollen extract
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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: 13 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Elite Bronze Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 4 - Non-Preferred ✓ — — PA
Standard Silver Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Standard Silver with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Standard Gold with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Complete Gold + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Silver + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Gold + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Complete Gold Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Standard Gold Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze Tier 4 - Non-Preferred ✓ — — PA
Clear Silver with $0 Insulin Options Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze Tier 4 - Non-Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 13 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Advantage 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Local 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Care 2026 Tier 4 - Higher Cost Brand — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 13 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver 3000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze 6500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Gold CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze RD CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Gold RD CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect myDiabetesCare Silver Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD 2200 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Gold 1500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect myDiabetesCare Bronze Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze 5500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze RD 6000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver 3500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD 3500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze 7000 HSA Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver 4400 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 13 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard (No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Standard (No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Standard (No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
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