Hyponatremia tolvaptan

15 MG — Tablet

Vasopressin V2 Receptor Antagonist

GoodRx Compare Prices

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: 16 hours, 9 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 16 hours, 9 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 120 per 30 days PA | QL
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 120 per 30 days PA | QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 120 per 30 days PA | QL
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic ✓ — ✓ 120 per 30 days PA | QL
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
Erickson Advantage Signature (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
Erickson Advantage Freedom (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
Erickson Advantage Liberty (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
Erickson Advantage Champion (HMO-POS C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 120 per 30 days PA | QL
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Access (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Assist Open (PPO) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Liberty Open (PPO D-SNP) Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
Troy Medicare (HMO) Tier 5 - Specialty ✓ — — PA
Alignment Health AVA (PPO) Tier 5 - Specialty ✓ — — PA
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
Alignment Health Platinum Select (HMO) Tier 5 - Specialty ✓ — — PA
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 5 - Specialty ✓ — — PA
Alignment Health smartHMO (HMO) Tier 5 - Specialty ✓ — — PA
Alignment Health NC Duals (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Alignment Health Platinum (HMO) Tier 5 - Specialty ✓ — — PA
Wellcare Giveback Open (PPO) Tier 5 - Specialty ✓ — — PA
Wellcare Simple (HMO-POS) Tier 5 - Specialty ✓ — — PA
Wellcare Simple Open (PPO) Tier 5 - Specialty ✓ — — PA
Liberty Medicare Advantage (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
HealthSpring Preferred Plus (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
HealthSpring Preferred Savings (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
HealthSpring Preferred Select (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
HealthSpring Preferred (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
HealthSpring TotalCare Plus (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
HealthSpring TotalCare (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
HealthSpring True Choice (PPO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Senior Care (HMO I-SNP) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
Something not right?