Jubbonti
Generic: denosumab-bbdz
60 MG — Prefilled Syringe
Bone Resorption Suppression And Related Agents
Also known as:
denosumab-bbdz
Prolia Biosimilar
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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.
Medicare Part D
163 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Wyost |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 2 per 365 days | QL |
|
NHC Advantage (HMO I-SNP)
via Wyost |
Tier 1 - Preferred Generic | ✓ | — | ✓ 1.7 per 28 days | PA | QL |
|
PruittHealth Premier (HMO I-SNP)
via Wyost |
Tier 1 - Preferred Generic | ✓ | — | ✓ 1.7 per 28 days | PA | QL |
|
Longevity Health Plan (HMO I-SNP)
via Wyost |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Wyost |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Wyost |
Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 2 per 365 days | QL |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | ✓ | ✓ 1 per 168 days | ST | QL |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | ✓ | ✓ 1 per 168 days | ST | QL |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | ✓ | ✓ 1 per 168 days | ST | QL |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | ✓ | ✓ 1 per 168 days | ST | QL |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 1 per 180 days | QL |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 2 per 365 days | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Wyost |
Tier 1 - Preferred Generic | ✓ | — | ✓ 1.7 per 28 days | PA | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Wyost |
Tier 1 - Preferred Generic | ✓ | — | ✓ 1.7 per 28 days | PA | QL |
| Troy Medicare (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 1 per 180 days | QL |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 3 - Preferred Brand | — | ✓ | ✓ 1 per 168 days | ST | QL |
| Senior Care (HMO I-SNP) | Tier 3 - Preferred Brand | — | ✓ | ✓ 1 per 168 days | ST | QL |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| Alignment Health Platinum (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health smartHMO (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health Platinum Select (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Erickson Advantage Signature (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| Erickson Advantage Freedom (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| Erickson Advantage Liberty (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| Alignment Health AVA (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HealthTeam Advantage Plan I (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 2 per 365 days | QL |
| HealthTeam Advantage Plan II (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 2 per 365 days | QL |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 2 per 365 days | QL |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 2 per 365 days | QL |
| Blue Medicare PPO Enhanced (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Blue Medicare Essential Plus (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Blue Medicare Enhanced (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Blue Medicare Choice (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Blue Medicare Essential (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Experience Health Medicare Advantage (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 180 days | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature Extra (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature Giveback (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Erickson Advantage Signature (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | ✓ 1.7 per 28 days | PA | QL |
|
Alignment Health AVA (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 001 NC (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 003 NC (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 005 NC (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE 008 NC (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthTeam Advantage Plan I (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
HealthTeam Advantage Plan II (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Dual (HMO D-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Value Plus (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Prime (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Signature Care (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Enhanced (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Blue Medicare PPO Enhanced (PPO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Blue Medicare Essential Plus (HMO-POS)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Blue Medicare Enhanced (HMO-POS)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Blue Medicare Choice (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Blue Medicare Essential (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Experience Health Medicare Advantage (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Senior Care (HMO I-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | ✓ 1.7 per 28 days | PA | QL |
|
Troy Medicare (HMO)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Wyost |
Tier 5 - Specialty | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health smartHMO (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health Platinum Select (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED CORE 001 NC (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Wyost |
Tier 5 - Specialty | ✓ | — | — | PA |
NC Medicaid PDL
1 planOscar Health
26 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Bronze Classic Standard | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Classic Standard | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Gold Classic Standard | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Secure | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Bronze Classic 4700 | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Classic | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Simple Diabetes | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Simple PCP Saver | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Bronze Simple Diabetes | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| AIAN Cost Share | Tier 5 - Specialty | — | — | ✓ | QL |
| AIAN Cost Share | with Atrium Health | Tier 5 - Specialty | — | — | ✓ | QL |
| Secure | Tier 5 - Specialty | — | — | ✓ | QL |
| Bronze Classic Standard | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Simple Diabetes | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Simple PCP Saver | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Classic | Tier 5 - Specialty | — | — | ✓ | QL |
| Bronze Classic 4700 | Tier 5 - Specialty | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | Tier 5 - Specialty | — | — | ✓ | QL |
| Gold Classic Standard | Tier 5 - Specialty | — | — | ✓ | QL |
| Silver Classic Standard | Tier 5 - Specialty | — | — | ✓ | QL |