habitrol pt24

Generic: habitrol

21mg

Also known as: habitrol pt24 21mg/24hr Habitrol Pt24 21mg/24hr

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

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 15 hours, 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Enhanced Asthma/COPD Care Silver with $0 Drug Options via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Gold + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Silver with Atrium Health + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Gold with Atrium Health + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Complete Gold via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver with Atrium Health + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold with Atrium Health + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Complete Gold via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Clear Silver with $0 Insulin Options via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze with Atrium Health via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze with Atrium Health via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Focused Silver with Atrium Health via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Complete Gold with Atrium Health via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze with Atrium Health via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver with Atrium Health via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold with Atrium Health via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Complete Gold + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via Habitrol	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Elite Bronze via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Clear Silver with $0 Insulin Options via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Expanded Bronze via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Silver via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Gold via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Everyday Bronze with Atrium Health via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Elite Bronze with Atrium Health via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Focused Silver with Atrium Health via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Complete Gold with Atrium Health via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Expanded Bronze with Atrium Health via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Silver with Atrium Health via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Gold with Atrium Health via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Complete Gold + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Everyday Bronze + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Elite Bronze + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Expanded Bronze + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None
Standard Silver + Vision + Adult Dental via nicotine	Tier 0 - $0 Preventive	—	—	—	None

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 15 hours, 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 70/30 Standard PPO 2026	Tier 0 - $0 Copay (ACA Preventive)	—	—	—	None
NC State Health Plan - HDHP 2026	Tier 0 - $0 Copay (ACA Preventive)	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026	Tier 0 - $0 Copay (ACA Preventive)	—	—	—	None

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 15 hours, 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via nicotine	Tier 1 - Basic Core Formulary	✓	—	—	PA

UnitedHealthcare

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 15 hours, 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026 via Habitrol	Tier 1 - $0 Copay Preventive	—	—	—	None