irbesartan
75 mg, 150 mg, 300 mg — Tablet
Also known as:
Avapro
irbesartan tabs 75mg, 150mg, 300mg
irbesartan tab 75 mg, 150 mg, 300 mg
Irbesartan 75 Mg Tablet
Irbesartan 150 Mg Tablet
Irbesartan 300 Mg Tablet
Irbesartan Oral Tablet
Compare Prices
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 |
|---|---|---|---|---|---|
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + 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 Silver Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
4 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 |
|
BCBS Federal Standard Option 2026
via Avapro |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Care 2026
via Avapro |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Value 2026
via Avapro |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Avapro |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Avapro |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Local 2026
via Avapro |
Tier 1 - Lowest Cost Generic | — | — | — | None |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Silver 3000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect myDiabetesCare Bronze | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze 5500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver 3500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver RD 5000 Indiv Med Deductible | 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 Silver RD 3500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze 6500 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 Bronze RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Gold CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Gold RD CMS Standard | Tier 2 - Generic | — | — | — | None |
Medicare Part D
140 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Humana Gold Choice H8145-004 (PFFS) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| Erickson Advantage Signature (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Erickson Advantage Freedom (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| Erickson Advantage Liberty (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Dual (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Value Plus (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Prime (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature Care (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Enhanced (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature Extra (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature Giveback (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HealthSpring TotalCare (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HealthSpring Preferred (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HealthSpring Preferred Select (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HealthSpring Preferred Savings (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HealthSpring Preferred Plus (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED CORE 001 NC (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED CHOICE 001 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED CHOICE 003 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED CHOICE 005 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED CHOICE 008 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| 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 |
| 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 | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HumanaChoice H5216-211 (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Full Access H5525-034 (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HumanaChoice H5525-049 (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HumanaChoice H5525-050 (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HumanaChoice H5525-070 (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| HumanaChoice H5525-083 (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 1 - Preferred Generic | — | — | ✓ 30 per 30 days | QL |
| Senior Care (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Alignment Health AVA (PPO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Alignment Health Platinum (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Experience Health Medicare Advantage (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Wellcare Assist Open (PPO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Blue Medicare Essential (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Blue Medicare Choice (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Blue Medicare Enhanced (HMO-POS) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Alignment Health smartHMO (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Alignment Health Platinum Select (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Blue Medicare Essential Plus (HMO-POS) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Blue Medicare PPO Enhanced (PPO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Wellcare Giveback Open (PPO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Wellcare Simple (HMO-POS) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| Wellcare Simple Open (PPO) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 30 per 30 days | QL |
NC Medicaid PDL
2 plansNC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| 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 - HDHP 2026
via Avapro |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Avapro |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Avapro |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| 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 |
| Silver Simple PCP Saver | 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 |
| Secure | Tier 1 - Preferred Generic | — | — | — | None |
| Silver Classic | Tier 1 - Preferred Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | 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 |
| Silver Simple Diabetes | Tier 1 - Preferred Generic | — | — | — | None |
| Secure | with Atrium Health | Tier 1 - Preferred Generic | — | — | — | None |
| Gold Classic Standard | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
UnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Silver Standard (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 Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |