Hyponatremia tolvaptan

15 MG — Tablet

Vasopressin V2 Receptor Antagonist

Also known as: Tolvaptan (Hyponatremia) Oral 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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 15 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Elite Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental 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
Standard Expanded Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Source: CMS QHP JSON  ·  Checked: 17 hours, 15 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 5 - Specialty ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 17 hours, 15 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
Liberty Medicare Dual Plan (HMO D-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
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 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
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
AARP Medicare Advantage from UHC NC-24 (HMO-POS) 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
HealthSpring TotalCare Plus (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
HealthSpring Preferred (HMO) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
HealthSpring Preferred Select (HMO) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
HealthSpring Preferred Savings (HMO) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
HealthSpring Preferred Plus (HMO) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
HealthSpring True Choice (PPO) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
Senior Care (HMO I-SNP) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
HealthSpring TotalCare (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Liberty Medicare Advantage (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 120 per 30 days PA | QL
Wellcare Simple Open (PPO) Tier 5 - Specialty ✓ — — PA
Wellcare Simple (HMO-POS) Tier 5 - Specialty ✓ — — PA
Wellcare Giveback Open (PPO) Tier 5 - Specialty ✓ — — PA
Alignment Health Platinum (HMO) Tier 5 - Specialty ✓ — — PA
Alignment Health NC Duals (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Alignment Health smartHMO (HMO) Tier 5 - Specialty ✓ — — PA
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 5 - Specialty ✓ — — PA
Alignment Health Platinum Select (HMO) Tier 5 - Specialty ✓ — — PA
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
Alignment Health AVA (PPO) Tier 5 - Specialty ✓ — — PA
Troy Medicare (HMO) Tier 5 - Specialty ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Liberty Open (PPO D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Assist Open (PPO) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Access (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Source: CMS QHP JSON  ·  Checked: 17 hours, 15 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Secure | with Atrium Health Tier 5 - Specialty ✓ — — PA
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 5 - Specialty ✓ — — PA
Silver Classic | with Atrium Health Tier 5 - Specialty ✓ — — PA
Silver Simple Diabetes | with Atrium Health Tier 5 - Specialty ✓ — — PA
Silver Simple PCP Saver | with Atrium Health Tier 5 - Specialty ✓ — — PA
Gold Elite Saver Plus | with Atrium Health Tier 5 - Specialty ✓ — — PA
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 5 - Specialty ✓ — — PA
Bronze Simple Chronic Care CKM | with Atrium Health Tier 5 - Specialty ✓ — — PA
Bronze Simple Diabetes | with Atrium Health Tier 5 - Specialty ✓ — — PA
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 5 - Specialty ✓ — — PA
Silver Simple Chronic Care CKM | with Atrium Health Tier 5 - Specialty ✓ — — PA
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 5 - Specialty ✓ — — PA
AIAN Cost Share Tier 5 - Specialty ✓ — — PA
AIAN Cost Share | with Atrium Health Tier 5 - Specialty ✓ — — PA
Bronze Classic Standard Tier 5 - Specialty ✓ — — PA
Silver Classic Standard Tier 5 - Specialty ✓ — — PA
Gold Classic Standard Tier 5 - Specialty ✓ — — PA
Bronze Classic Standard | with Atrium Health Tier 5 - Specialty ✓ — — PA
Silver Classic Standard | with Atrium Health Tier 5 - Specialty ✓ — — PA
Gold Classic Standard | with Atrium Health Tier 5 - Specialty ✓ — — PA
Bronze Elite + PCP Saver Plus Tier 5 - Specialty ✓ — — PA
Silver Classic Tier 5 - Specialty ✓ — — PA
Secure Tier 5 - Specialty ✓ — — PA
Bronze Classic 4700 Tier 5 - Specialty ✓ — — PA
Silver Simple PCP Saver Tier 5 - Specialty ✓ — — PA
Gold Elite Saver Plus Tier 5 - Specialty ✓ — — PA
Silver Simple Diabetes Tier 5 - Specialty ✓ — — PA
Bronze Classic 4700 | with Atrium Health Tier 5 - Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 17 hours, 15 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Standard (No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard (No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Standard (No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
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