Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Blue Cross Blue Shield of NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Local 2026
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Care 2026
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Value 2026
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Value 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Advantage 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Local 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Care 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Advantage 2026
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
Medicare Part D
102 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
PruittHealth Premier (HMO I-SNP)
via Hadlima |
Tier 1 - Preferred Generic | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Hadlima |
Tier 1 - Preferred Generic | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Longevity Health Plan (HMO I-SNP)
via Hadlima |
Tier 1 - Preferred Generic | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Hadlima |
Tier 1 - Preferred Generic | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
NHC Advantage (HMO I-SNP)
via Hadlima |
Tier 1 - Preferred Generic | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Aetna Medicare Signature Giveback (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (HMO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Dual (HMO D-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (HMO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Value Plus (HMO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Prime (HMO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature Care (HMO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Enhanced (HMO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Enhanced (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Enhanced (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature Extra (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature Giveback (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
HealthSpring True Choice (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
HealthSpring TotalCare (HMO D-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
HealthSpring Preferred (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
HealthSpring Preferred Select (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
HealthSpring Preferred Savings (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
HealthSpring Preferred Plus (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CORE 001 NC (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CORE 001 NC (HMO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED GIVEBACK 002 NC (HMO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED GIVEBACK 012 NC (HMO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE 001 NC (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE 003 NC (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE 005 NC (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE 008 NC (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE 001 NC (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE 003 NC (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE 005 NC (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE 008 NC (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via adalimumab-bwwd |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Senior Care (HMO I-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Aetna Medicare Signature (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Dual (HMO D-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Value Plus (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Prime (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature Care (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Enhanced (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Enhanced (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Enhanced (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature Extra (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 22.40 per 365 days | PA | QL |
|
Alignment Health Platinum Select (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Alignment Health AVA (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Blue Medicare PPO Enhanced (PPO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Blue Medicare Essential Plus (HMO-POS)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Blue Medicare Enhanced (HMO-POS)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Blue Medicare Choice (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Blue Medicare Essential (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Experience Health Medicare Advantage (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Alignment Health Platinum (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Alignment Health smartHMO (HMO)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Hadlima |
Tier 5 - Specialty | ✓ | — | ✓ 2.4 per 28 days | PA | QL |