isosorbide mononitrate

30 mg, 60 mg, 120 mg — Extended Release Tablet

OXYTOCICS

Also known as: ISOSORBIDE MONONITRATE TABS 10MG, 20MG isosorbide mononitrate tab er 24hr 30 mg, 60 mg, 120 mg Isosorbide Mononitrate 10 Mg Tablet Isosorbide Mononitrate 20 Mg Tablet Isosorbide Mononitrate Er 30 Mg Tablet Isosorbide Mononitrate Er 60 Mg Tablet Isosorbide Mononitrate Er 120 Mg Tablet isosorbide mononitrate tb24 30mg, 60mg, 120mg ISOSORBIDE MONONITRATE ER ISOSORBIDE MONONITRATE TABS 10MG,
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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: 16 hours, 10 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold Tier 1 - Preferred Generic — — — None
Everyday Bronze Tier 1 - Preferred Generic — — — None
Elite Bronze Tier 1 - Preferred Generic — — — None
Standard Silver with Atrium Health Tier 1 - Preferred Generic — — — None
Standard Gold with Atrium Health Tier 1 - Preferred Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Complete Gold + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Everyday Bronze + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Elite Bronze + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Standard Gold with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Clear Silver with $0 Insulin Options Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze Tier 1 - Preferred Generic — — — None
Standard Silver with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Complete Gold with Atrium Health Tier 1 - Preferred Generic — — — None
Focused Silver with Atrium Health Tier 1 - Preferred Generic — — — None
Elite Bronze with Atrium Health Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Standard Silver Tier 1 - Preferred Generic — — — None
Standard Gold Tier 1 - Preferred Generic — — — None
Everyday Bronze with Atrium Health Tier 1 - Preferred Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 1 - Preferred Generic — — — None
Standard Gold + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Standard Silver + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze with Atrium Health Tier 1 - Preferred Generic — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 10 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026 Tier 1 - Generic — — — None
BCBS Federal Focus 2026 Tier 1 - Generic — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 10 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 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 Home with UNC Health Alliance 2026 Tier 1 - Lowest Cost Generic — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 16 hours, 10 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026 Tier 1 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 16 hours, 10 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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
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 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 DUAL FULL 013 NC (HMO D-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 1 - Preferred Generic — — — None
DEVOTED DUAL 009 NC (HMO D-SNP) 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
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
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 1 - Preferred Generic — — — None
Wellcare Simple Open (PPO) Tier 1 - Preferred Generic — — — None
Wellcare Simple (HMO-POS) Tier 1 - Preferred Generic — — — None
Wellcare Giveback Open (PPO) Tier 1 - Preferred Generic — — — None
Blue Medicare PPO Enhanced (PPO) Tier 1 - Preferred Generic — — — None
Blue Medicare Essential Plus (HMO-POS) Tier 1 - Preferred Generic — — — None
Blue Medicare Enhanced (HMO-POS) Tier 1 - Preferred Generic — — — None
Blue Medicare Choice (HMO) Tier 1 - Preferred Generic — — — None
Blue Medicare Essential (HMO) Tier 1 - Preferred Generic — — — None
Experience Health Medicare Advantage (HMO) Tier 1 - Preferred Generic — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) 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
Troy Medicare (HMO) Tier 1 - Preferred Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas VIP Care (HMO 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
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Erickson Advantage Signature (HMO-POS) 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
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) 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
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
Senior Care (HMO I-SNP) Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO) Tier 2 - Generic — — — None
Aetna Medicare Dual (HMO D-SNP) Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO) Tier 2 - Generic — — — None
Aetna Medicare Value Plus (HMO) Tier 2 - Generic — — — None
Aetna Medicare Prime (HMO) Tier 2 - Generic — — — None
Aetna Medicare Signature Care (HMO) Tier 2 - Generic — — — None
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (HMO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature Extra (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature Giveback (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Liberty Medicare Advantage (HMO C-SNP) Tier 2 - Generic — — — None
Alignment Health Platinum (HMO) Tier 2 - Generic — — — None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 2 - Generic — — — None
Alignment Health smartHMO (HMO) Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 2 - Generic — — — None
Alignment Health Platinum Select (HMO) Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 2 - Generic — — — None
Alignment Health AVA (PPO) Tier 2 - Generic — — — None
HealthTeam Advantage Plan I (PPO) Tier 2 - Generic — — — None
HealthTeam Advantage Plan II (PPO) Tier 2 - Generic — — — None
HealthTeam Advantage Vitality Plan (PPO) Tier 2 - Generic — — — None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 2 - Generic — — — None
Wellcare Assist Open (PPO) Tier 2 - Generic — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 2 - Generic — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 2 - Generic — — — None
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 2 - Generic — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 6 - Specialty Plus — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 10 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via isosorbide mononitrate tb24 		Tier 1 - Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via isosorbide mononitrate tb24 		Tier 1 - Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via isosorbide mononitrate tb24 		Tier 1 - Preferred Generic — — — None
NC State Health Plan - HDHP 2026 Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 3 - Non-Preferred Brand — — — None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 16 hours, 10 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Basic Core Formulary — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 16 hours, 10 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026
via isosorbide mononitrate er 		Tier 2 - Lower Cost — — — None
UnitedHealthcare NC Individual & Family 2026 Tier 2 - Lower Cost — — — None
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