Hydromorphone
12 Mg — Tablet
Opioid Analgesics — Long Acting Opioids
Also known as:
Exalgo
Dilaudid
Hydromorphone 1 Mg/Ml Oral Solution
Hydromorphone 5 Mg/5 Ml Oral Solution
Hydromorphone 3 Mg Suppository
Hydromorphone 2 Mg Tablet
Hydromorphone 4 Mg Tablet
Hydromorphone 8 Mg Tablet
Hydromorphone Er 8 Mg Tablet
Hydromorphone Er 12 Mg Tablet
Hydromorphone Er 16 Mg Tablet
Hydromorphone Er 32 Mg Tablet
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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.
Blue Cross Blue Shield Federal
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Dilaudid |
Tier 3 - Non-Preferred Brand | — | — | ✓ | QL |
|
BCBS Federal Standard Option 2026
via Dilaudid |
Tier 3 - Non-Preferred Brand | — | — | ✓ | QL |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Local 2026
via Dilaudid |
Tier 1 - Lowest Cost Generic | — | — | ✓ | QL |
|
BCBSNC Blue Value 2026
via Dilaudid |
Tier 1 - Lowest Cost Generic | — | — | ✓ | QL |
|
BCBSNC Blue Advantage 2026
via Dilaudid |
Tier 1 - Lowest Cost Generic | — | — | ✓ | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Dilaudid |
Tier 1 - Lowest Cost Generic | — | — | ✓ | QL |
|
BCBSNC Blue Care 2026
via Dilaudid |
Tier 1 - Lowest Cost Generic | — | — | ✓ | QL |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver 3500 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver 4400 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver 3000 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze 6500 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect myDiabetesCare Silver | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Gold 1500 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect myDiabetesCare Bronze | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze 5500 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Gold RD CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze RD CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Gold CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver RD CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
Medicare Part D
68 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 2400 per 30 days | QL |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 600 per 30 days | QL |
| Wellcare Giveback Open (PPO) | Tier 2 - Generic | — | — | ✓ 600 per 30 days | QL |
| Wellcare Simple (HMO-POS) | Tier 2 - Generic | — | — | ✓ 600 per 30 days | QL |
| Wellcare Simple Open (PPO) | Tier 2 - Generic | — | — | ✓ 600 per 30 days | QL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 600 per 30 days | QL |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 2 - Generic | — | — | ✓ 600 per 30 days | QL |
| Wellcare Assist Open (PPO) | Tier 2 - Generic | — | — | ✓ 600 per 30 days | QL |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 600 per 30 days | QL |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 600 per 30 days | QL |
| Alignment Health Platinum (HMO) | Tier 3 - Preferred Brand | — | — | ✓ 1440 per 30 days | QL |
| Alignment Health smartHMO (HMO) | Tier 3 - Preferred Brand | — | — | ✓ 1440 per 30 days | QL |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 1440 per 30 days | QL |
| Alignment Health Platinum Select (HMO) | Tier 3 - Preferred Brand | — | — | ✓ 1440 per 30 days | QL |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 1440 per 30 days | QL |
| Alignment Health AVA (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 1440 per 30 days | QL |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 1440 per 30 days | QL |
| Blue Medicare PPO Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 1440 per 30 days | QL |
| Blue Medicare Essential Plus (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1440 per 30 days | QL |
| Blue Medicare Enhanced (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1440 per 30 days | QL |
| Blue Medicare Choice (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 1440 per 30 days | QL |
| Blue Medicare Essential (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 1440 per 30 days | QL |
| Experience Health Medicare Advantage (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 1440 per 30 days | QL |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1440 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Dual (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Value Plus (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Prime (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Signature Care (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Enhanced (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Signature Extra (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Signature Giveback (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| HealthSpring True Choice (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 2400 per 30 days | QL |
| HealthSpring TotalCare (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 2400 per 30 days | QL |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 2400 per 30 days | QL |
| HealthSpring Preferred (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 2400 per 30 days | QL |
| HealthSpring Preferred Select (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 2400 per 30 days | QL |
| HealthSpring Preferred Savings (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 2400 per 30 days | QL |
| HealthSpring Preferred Plus (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 2400 per 30 days | QL |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED CORE 001 NC (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED CHOICE 001 NC (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED CHOICE 003 NC (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED CHOICE 005 NC (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED CHOICE 008 NC (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 600 per 30 days | QL |
NC Medicaid PDL
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - HDHP 2026
via Dilaudid |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Dilaudid |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Dilaudid |
Tier 3 - Non-Preferred Brand | — | — | — | None |