Livalo

Generic: pitavastatin calcium

1MG, 2MG, 4MG — Tablet

HMG COA REDUCTASE INHIBITORS

Also known as: pitavastatin calcium LIVALO TABS 1MG, 2MG, 4MG
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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: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 15 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via pitavastatin calcium 		Tier 1 - Generic — — — NCTM None
BCBS Federal Basic Option 2026
via pitavastatin calcium 		Tier 1 - Generic — — — NCTM None
BCBS Federal Focus 2026
via pitavastatin calcium 		Tier 1 - Generic — — — NCTM None
BCBS Federal Standard Option 2026 Tier 3 - Non-Preferred Brand — — — None
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 15 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED CHOICE 008 NC (PPO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED CHOICE 005 NC (PPO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
Longevity Health Plan (HMO I-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
HealthSpring True Choice (PPO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
HealthSpring TotalCare (HMO D-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
HealthSpring TotalCare Plus (HMO D-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
HealthSpring Preferred (HMO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
HealthSpring Preferred Select (HMO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
HealthSpring Preferred Savings (HMO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
HealthSpring Preferred Plus (HMO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED DUAL 009 NC (HMO D-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED CORE 001 NC (HMO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED GIVEBACK 002 NC (HMO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED GIVEBACK 012 NC (HMO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED CHOICE 001 NC (PPO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED CHOICE 003 NC (PPO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via pitavastatin calcium 		Tier 1 - Preferred Generic — ✓ ✓ 30 per 30 days ST | QL
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP)
via pitavastatin calcium 		Tier 1 - Preferred Generic — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Erickson Advantage Signature (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Erickson Advantage Freedom (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Erickson Advantage Liberty (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Erickson Advantage Champion (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Liberty Open (PPO D-SNP)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Access (HMO-POS D-SNP)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Liberty (HMO-POS D-SNP)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Dual Reserve (HMO-POS D-SNP)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Simple Open (PPO)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Simple (HMO-POS)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
Wellcare Giveback Open (PPO)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
HealthTeam Advantage Plan I (PPO)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan II (PPO)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Vitality Plan (PPO)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — — None
Wellcare Assist Open (PPO)
via pitavastatin calcium 		Tier 4 - Non-Preferred — — ✓ 30 per 30 days QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via pitavastatin calcium 		Tier 6 - Specialty Plus — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 15 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via pitavastatin calcium 		Tier 0 - $0 Copay (ACA Preventive) — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via pitavastatin calcium 		Tier 0 - $0 Copay (ACA Preventive) — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via pitavastatin calcium 		Tier 0 - $0 Copay (ACA Preventive) — — — None
NC State Health Plan - HDHP 2026 Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 15 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via pitavastatin calcium 		Tier 3 - Non-Formulary ✓ — — PA
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