Halcion
Generic: triazolam
25MG — Tablet
Sedative Hypnotics — Quantity limits apply to all sedative hypnotics
Also known as:
HALCION TABS .25MG
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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)
29 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Standard Silver with Atrium Health
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via triazolam |
Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via triazolam |
Tier 1 - Generic | — | — | ✓ | QL |
|
BCBS Federal Standard Option 2026
via triazolam |
Tier 1 - Generic | — | — | ✓ | QL |
|
BCBS Federal Focus 2026
via triazolam |
Tier 1 - Generic | — | — | ✓ | QL |
| BCBS Federal Basic Option 2026 | Tier 3 - Non-Preferred Brand | — | — | ✓ | QL |
| BCBS Federal Standard Option 2026 | Tier 3 - Non-Preferred Brand | — | — | ✓ | QL |
Blue Cross Blue Shield of NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 1 - Lowest Cost Generic | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Local 2026 | Tier 1 - Lowest Cost Generic | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Care 2026 | Tier 1 - Lowest Cost Generic | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Value 2026 | Tier 1 - Lowest Cost Generic | ✓ | — | — Restricted Access | PA |
|
BCBSNC Blue Advantage 2026
via triazolam |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Local 2026
via triazolam |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Care 2026
via triazolam |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Value 2026
via triazolam |
Tier 1 - Lowest Cost Generic | — | — | — | None |
| BCBSNC Blue Advantage 2026 | Tier 1 - Lowest Cost Generic | ✓ | — | — Restricted Access | PA |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via triazolam |
Tier 1 - Lowest Cost Generic | — | — | — | None |
Cigna
1 planMedicare Part D
18 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Aetna Medicare Enhanced (PPO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Signature Extra (PPO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Signature Giveback (PPO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Dual (HMO D-SNP)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Signature (HMO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Value Plus (HMO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Prime (HMO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Signature Care (HMO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Enhanced (HMO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Enhanced (PPO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
|
Aetna Medicare Signature (HMO)
via triazolam |
Tier 4 - Non-Preferred | ✓ | — | ✓ 60 per 30 days | PA | QL |
NC Medicaid PDL
2 plansNC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 70/30 Standard PPO 2026
via triazolam |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - 80/20 Plus PPO 2026
via triazolam |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - HDHP 2026
via triazolam |
Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 3 - Non-Preferred Brand | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 3 - Non-Preferred Brand | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - HDHP 2026 | Tier 3 - Non-Preferred Brand | ✓ | — | ✓ | PA | QL |