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)
29 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Standard Gold with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Complete Gold + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | 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 |
| 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 |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Standard Silver + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Standard Gold + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Standard Expanded Bronze 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 Gold | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Complete Gold | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | 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 |
| Standard Expanded Bronze with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Standard Silver with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Everyday Bronze | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Elite Bronze | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Standard Expanded Bronze | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Standard Silver | Tier 1 - Preferred Generic | — | — | ✓ | QL |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 1 - Lowest Cost Generic | — | — | — | None |
| BCBSNC Blue Value 2026 | Tier 1 - Lowest Cost Generic | — | — | — | None |
| BCBSNC Blue Advantage 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 |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver 3500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze 5500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver 3000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver 4400 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect myDiabetesCare Bronze | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Gold 1500 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 6500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Gold RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Gold CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD CMS Standard | Tier 2 - Generic | — | — | — | None |
Medicare Part D
140 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| 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 |
| Aetna Medicare Signature (HMO) | 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 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 |
| 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 |
| 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 |
| Senior Care (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health Platinum (HMO) | Tier 6 - Specialty Plus | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-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 |
| 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 |
| Wellcare Giveback Open (PPO) | Tier 6 - Specialty Plus | — | — | — | None |
| Wellcare Simple (HMO-POS) | Tier 6 - Specialty Plus | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 6 - Specialty Plus | — | — | — | None |
| DEVOTED DUAL 009 NC (HMO D-SNP) | 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 |
| Blue Medicare Enhanced (HMO-POS) | 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 |
| 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 |
| Alignment Health Platinum Select (HMO) | Tier 6 - Specialty Plus | — | — | — | None |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 6 - Specialty Plus | — | — | — | None |
| Alignment Health smartHMO (HMO) | 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| 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 - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 1 - Preferred Generic | — | — | — | None |
Oscar Health
56 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Silver Simple PCP Saver | with Atrium Health | Tier 1 - Preferred Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 1 - Preferred Generic | — | — | — | None |
| Silver Classic | Tier 1 - Preferred Generic | — | — | — | None |
| Secure | Tier 1 - Preferred Generic | — | — | — | None |
| Bronze Classic 4700 | Tier 1 - Preferred Generic | — | — | — | None |
| Silver Simple PCP Saver | Tier 1 - Preferred Generic | — | — | — | None |
| Gold Elite Saver Plus | Tier 1 - Preferred Generic | — | — | — | None |
| Silver Simple Diabetes | Tier 1 - Preferred Generic | — | — | — | None |
| Secure | with Atrium Health | Tier 1 - Preferred Generic | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 1 - Preferred Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 1 - Preferred Generic | — | — | — | None |
| Silver Classic | 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 Chronic Care CKM | with Atrium Health | Tier 1 - Preferred Generic | — | — | — | None |
| Bronze Simple Diabetes | 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 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 |
| 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 |
| Bronze Classic Standard | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | Tier 2 - Generic | — | — | — | None |
| Gold Classic Standard | Tier 2 - Generic | — | — | — | None |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Silver Simple PCP Saver | with Atrium Health
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Gold Elite Saver Plus | 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 |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Bronze Simple Diabetes | 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 |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
AIAN Cost Share
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
AIAN Cost Share | with Atrium Health
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Bronze Classic Standard
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Silver Classic Standard
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Gold Classic Standard
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Bronze 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 |
|
Gold Classic Standard | with Atrium Health
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Bronze Elite + PCP Saver Plus
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Silver Classic
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Secure
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Bronze Classic 4700
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Silver Simple PCP Saver
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Gold Elite Saver Plus
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Silver Simple Diabetes
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Secure | with Atrium Health
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Bronze Classic 4700 | 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 |
|
Silver Classic | with Atrium Health
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
|
Silver Simple Diabetes | with Atrium Health
via Aldactazide |
Tier 3 - Preferred Brand | — | — | — | None |
TRICARE
1 planUnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Gold Standard (No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Silver Standard (No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| UHC Bronze Standard (No Referrals) | Tier 0 - $0 Preventive | — | — | ✓ | QL |