hydrochlorothiazide

10 mg/mL, 12.5 mg, 25 mg, 50 mg — Tablet

DIURETICS

Also known as: hydrochlorothiazide oral hydrochlorothiazide caps 12.5mg; tabs 12.5mg, 25mg, 50mg hydrochlorothiazide cap 12.5 mg hydrochlorothiazide tab 12.5 mg, 25 mg, 50 mg Hydrochlorothiazide 12.5 Mg Capsule Hydrochlorothiazide 12.5 Mg Tablet Hydrochlorothiazide 25 Mg Tablet Hydrochlorothiazide 50 Mg Tablet INZIRQO hydrochlorothiazide caps 12.5mg; tabs 12.5mg,
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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: 17 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Standard Expanded Bronze Tier 1 - Preferred Generic — — ✓ QL
Clear Silver with $0 Insulin Options Tier 1 - Preferred Generic — — ✓ QL
Elite Bronze Tier 1 - Preferred Generic — — ✓ QL
Everyday Bronze Tier 1 - Preferred Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 1 - Preferred Generic — — ✓ QL
Complete Gold Tier 1 - Preferred Generic — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Elite Bronze + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Standard Gold + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Standard Silver + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Complete Gold + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 1 - Preferred Generic — — ✓ QL
Standard Gold with Atrium Health Tier 1 - Preferred Generic — — ✓ QL
Standard Silver with Atrium Health Tier 1 - Preferred Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health Tier 1 - Preferred Generic — — ✓ QL
Complete Gold with Atrium Health Tier 1 - Preferred Generic — — ✓ QL
Focused Silver with Atrium Health Tier 1 - Preferred Generic — — ✓ QL
Elite Bronze with Atrium Health Tier 1 - Preferred Generic — — ✓ QL
Everyday Bronze with Atrium Health Tier 1 - Preferred Generic — — ✓ QL
Standard Gold Tier 1 - Preferred Generic — — ✓ QL
Standard Silver Tier 1 - Preferred Generic — — ✓ QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026 Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026 Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026 Tier 1 - Generic — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026 Tier 1 - Lowest Cost Generic — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026 Tier 1 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 17 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Aetna Medicare Signature Care (HMO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Aetna Medicare Enhanced (HMO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Signature (PPO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Enhanced (PPO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Enhanced (PPO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Signature Extra (PPO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Signature (PPO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Signature (PPO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Signature Giveback (PPO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Signature (PPO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Chronic Care (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
HealthSpring True Choice (PPO) Tier 1 - Preferred Generic — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 1 - Preferred Generic — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 1 - Preferred Generic — — — None
HealthSpring Preferred (HMO) Tier 1 - Preferred Generic — — — None
HealthSpring Preferred Select (HMO) Tier 1 - Preferred Generic — — — None
HealthSpring Preferred Savings (HMO) Tier 1 - Preferred Generic — — — None
HealthSpring Preferred Plus (HMO) Tier 1 - Preferred Generic — — — None
DEVOTED CORE 001 NC (HMO) Tier 1 - Preferred Generic — — — None
DEVOTED GIVEBACK 002 NC (HMO) Tier 1 - Preferred Generic — — — None
DEVOTED GIVEBACK 012 NC (HMO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE 001 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE 003 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE 005 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE 008 NC (PPO) Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage (HMO C-SNP) Tier 1 - Preferred Generic — — — None
HealthTeam Advantage Plan I (PPO) Tier 1 - Preferred Generic — — — None
HealthTeam Advantage Plan II (PPO) Tier 1 - Preferred Generic — — — None
HealthTeam Advantage Vitality Plan (PPO) Tier 1 - Preferred Generic — — — None
Senior Care (HMO I-SNP) Tier 1 - Preferred Generic — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Signature (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Freedom (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Liberty (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Champion (HMO-POS C-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Aetna Medicare Signature (HMO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Dual (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Aetna Medicare Signature (HMO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Value Plus (HMO) Tier 1 - Preferred Generic — — — None
Aetna Medicare Prime (HMO) Tier 1 - Preferred Generic — — — None
Troy Medicare (HMO) Tier 1 - Preferred Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H1036-137 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H1036-233 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Dual Select H1036-307 (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H1036-335 (HMO-POS) Tier 1 - Preferred Generic — — — None
HumanaChoice Giveback H5216-017 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice H5216-211 (PPO) Tier 1 - Preferred Generic — — — None
Humana Full Access H5525-034 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice Giveback H5525-035 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 1 - Preferred Generic — — — None
HumanaChoice H5525-049 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice H5525-050 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice H5525-070 (PPO) Tier 1 - Preferred Generic — — — None
Humana Dual Select H5525-072 (PPO D-SNP) Tier 1 - Preferred Generic — — — None
HumanaChoice H5525-083 (PPO) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H6622-025 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H6622-026 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H6622-057 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H6622-060 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Plus H6622-061 (HMO-POS) Tier 1 - Preferred Generic — — — None
Humana Gold Choice H8145-004 (PFFS) Tier 1 - Preferred Generic — — — None
Wellcare Simple Open (PPO) Tier 6 - Specialty Plus — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 6 - Specialty Plus — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 6 - Specialty Plus — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 6 - Specialty Plus — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 6 - Specialty Plus — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 6 - Specialty Plus — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 6 - Specialty Plus — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 6 - Specialty Plus — — — None
Blue Medicare Essential Plus (HMO-POS) Tier 6 - Specialty Plus — — — None
Blue Medicare PPO Enhanced (PPO) Tier 6 - Specialty Plus — — — None
Wellcare Giveback Open (PPO) Tier 6 - Specialty Plus — — — None
Wellcare Simple (HMO-POS) Tier 6 - Specialty Plus — — — None
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 6 - Specialty Plus — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 6 - Specialty Plus — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 6 - Specialty Plus — — — None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 6 - Specialty Plus — — — None
Wellcare Assist Open (PPO) Tier 6 - Specialty Plus — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 6 - Specialty Plus — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 6 - Specialty Plus — — — None
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 6 - Specialty Plus — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 6 - Specialty Plus — — — None
Alignment Health AVA (PPO) Tier 6 - Specialty Plus — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 6 - Specialty Plus — — — None
Alignment Health Platinum Select (HMO) Tier 6 - Specialty Plus — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 6 - Specialty Plus — — — None
Alignment Health smartHMO (HMO) Tier 6 - Specialty Plus — — — None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 6 - Specialty Plus — — — None
Alignment Health Platinum (HMO) Tier 6 - Specialty Plus — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 6 - Specialty Plus — — — None
Experience Health Medicare Advantage (HMO) Tier 6 - Specialty Plus — — — None
Blue Medicare Essential (HMO) Tier 6 - Specialty Plus — — — None
Blue Medicare Choice (HMO) Tier 6 - Specialty Plus — — — None
Blue Medicare Enhanced (HMO-POS) Tier 6 - Specialty Plus — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic — — — None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 17 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Basic Core Formulary ✓ — — PA
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026 Tier 1 - $0 Copay Preventive — — — None
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