hydrochlorothiazide

Generic: Aldactazide

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

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, hydroCHLOROthiazide Oral Tablet hydroCHLOROthiazide Oral Capsule

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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)

34 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 18 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Enhanced Asthma/COPD Care Silver $0 Rx Options	Tier 1 - Preferred Generic	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options	Tier 1 - Preferred Generic	—	—	✓	QL
Streamlined Silver with Atrium Health	Tier 1 - Preferred Generic	—	—	✓	QL
Streamlined Silver	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Silver	Tier 1 - Preferred Generic	—	—	✓	QL
Signature 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
Elite Bronze + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Gold	Tier 1 - Preferred Generic	—	—	✓	QL
Everyday Bronze with Atrium Health	Tier 1 - Preferred Generic	—	—	✓	QL
Elite Bronze with Atrium Health	Tier 1 - Preferred Generic	—	—	✓	QL
Focused Silver with Atrium Health	Tier 1 - Preferred Generic	—	—	✓	QL
Complete Gold with Atrium Health	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Expanded Bronze with Atrium Health	Tier 1 - Preferred Generic	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Complete Gold + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Gold with Atrium Health	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Silver with Atrium Health	Tier 1 - Preferred Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Silver + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Gold + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental	Tier 1 - Preferred Generic	—	—	✓	QL
Complete Gold	Tier 1 - Preferred Generic	—	—	✓	QL

AmeriHealth Caritas NC

11 plans

Source: CMS QHP JSON · Formulary date: Sep 22, 2026 · Checked: 18 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 2 - Generic	—	—	—	None

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 18 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 1 - Generic	—	—	—	None
BCBS Federal Basic Option 2026	Tier 1 - Generic	—	—	—	None
BCBS Federal Focus 2026	Tier 1 - Generic	—	—	—	None

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 18 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Advantage 2026	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Value 2026	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Care 2026	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Local 2026	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 1 - Lowest Cost Generic	—	—	—	None

Cigna

20 plans

Source: PDF · Formulary date: Oct 7, 2026 · Checked: 18 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Silver 5000 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect Silver 3600 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect myDiabetesCare Bronze	Tier 1 - Preferred Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible	Tier 1 - Preferred Generic	—	—	—	None
Connect myDiabetesCare Silver	Tier 1 - Preferred Generic	—	—	—	None
Connect Bronze RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard	Tier 2 - Generic	—	—	—	None

Medicare Part D

140 plans

Source: CMS QHP JSON · Formulary date: Sep 16, 2026 · Checked: 18 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
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
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
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)	Tier 1 - Preferred Generic	—	—	✓ 60 per 30 days	QL
Troy Medicare (HMO)	Tier 1 - Preferred Generic	—	—	—	None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 1 - Preferred Generic	—	—	—	None
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
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
PruittHealth Premier (HMO I-SNP)	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
Senior Care (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
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
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
Humana Full Access H5525-034 (PPO)	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
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
Alignment Health Heart & Diabetes Care (HMO C-SNP)	Tier 6 - Specialty Plus	—	—	—	None
DEVOTED DUAL FULL 013 NC (HMO D-SNP)	Tier 6 - Specialty Plus	—	—	—	None
DEVOTED C-SNP PREMIUM 014 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 016 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 018 NC (HMO C-SNP)	Tier 6 - Specialty Plus	—	—	—	None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)	Tier 6 - Specialty Plus	—	—	—	None
DEVOTED DUAL 009 NC (HMO D-SNP)	Tier 6 - Specialty Plus	—	—	—	None
Wellcare Simple Open (PPO)	Tier 6 - Specialty Plus	—	—	—	None
Wellcare Simple (HMO-POS)	Tier 6 - Specialty Plus	—	—	—	None
Wellcare Giveback Open (PPO)	Tier 6 - Specialty Plus	—	—	—	None
Blue Medicare PPO Enhanced (PPO)	Tier 6 - Specialty Plus	—	—	—	None
Blue Medicare Essential Plus (HMO-POS)	Tier 6 - Specialty Plus	—	—	—	None
Blue Medicare Enhanced (HMO-POS)	Tier 6 - Specialty Plus	—	—	—	None
Blue Medicare Choice (HMO)	Tier 6 - Specialty Plus	—	—	—	None
Blue Medicare Essential (HMO)	Tier 6 - Specialty Plus	—	—	—	None
Experience Health Medicare Advantage (HMO)	Tier 6 - Specialty Plus	—	—	—	None
Healthy Blue + Medicare (HMO-POS D-SNP)	Tier 6 - Specialty Plus	—	—	—	None
Alignment Health Platinum (HMO)	Tier 6 - Specialty Plus	—	—	—	None
Alignment Health NC Duals (HMO-POS D-SNP)	Tier 6 - Specialty Plus	—	—	—	None
Alignment Health smartHMO (HMO)	Tier 6 - Specialty Plus	—	—	—	None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)	Tier 6 - Specialty Plus	—	—	—	None
Alignment Health Platinum Select (HMO)	Tier 6 - Specialty Plus	—	—	—	None
Alignment Health AVA (PPO)	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

NC State Health Plan

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 18 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	—	—	—	None
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

Oscar Health

56 plans

Source: CMS QHP JSON · Checked: 18 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
AIAN Cost Share	Tier 1 - Preferred Generic	—	—	—	None
AIAN Cost Share \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Silver Classic \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Bronze Classic 4700 \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Secure \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Silver Simple Diabetes	Tier 1 - Preferred Generic	—	—	—	None
Gold Elite Saver Plus	Tier 1 - Preferred Generic	—	—	—	None
Silver Simple PCP Saver	Tier 1 - Preferred Generic	—	—	—	None
Bronze Classic 4700	Tier 1 - Preferred Generic	—	—	—	None
Secure	Tier 1 - Preferred Generic	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Silver Classic	Tier 1 - Preferred Generic	—	—	—	None
Bronze Elite + PCP Saver Plus	Tier 1 - Preferred Generic	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Silver Simple Diabetes \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Gold Elite Saver Plus \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health	Tier 1 - Preferred Generic	—	—	—	None
Gold Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Gold Classic Standard	Tier 2 - Generic	—	—	—	None
Silver Classic Standard	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard	Tier 2 - Generic	—	—	—	None
Secure via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
AIAN Cost Share \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
AIAN Cost Share via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Gold Elite Saver Plus \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Simple Diabetes \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Classic \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Bronze Classic 4700 \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Secure \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Simple Diabetes via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Gold Elite Saver Plus via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Simple PCP Saver via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Bronze Classic 4700 via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Classic via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Bronze Elite + PCP Saver Plus via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Gold Classic Standard \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Classic Standard \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Bronze Classic Standard \| with Atrium Health via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Gold Classic Standard via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Silver Classic Standard via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None
Bronze Classic Standard via Aldactazide	Tier 3 - Preferred Brand	—	—	—	None

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jul 31, 2026 · Checked: 18 hours, 52 minutes ago

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

UnitedHealthcare

17 plans

Source: PDF · Formulary date: Sep 23, 2026 · Checked: 18 hours, 52 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	✓	QL
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None