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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.
Ambetter (Centene)
29 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Complete Gold | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Everyday Bronze | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Elite Bronze | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Silver | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Gold | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Elite Bronze with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Focused Silver with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Complete Gold with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Silver with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Standard Gold with Atrium Health | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
AmeriHealth Caritas NC
19 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Lucemyra |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Lucemyra |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Lucemyra |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Lucemyra |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Lucemyra |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Lucemyra |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Lucemyra |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Lucemyra |
Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Lucemyra |
Tier 5 - Specialty | — | — | — | None |
Blue Cross Blue Shield Federal
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Lucemyra |
Tier 3 - Non-Preferred Brand | — | — | ✓ | QL |
|
BCBS Federal Standard Option 2026
via Lucemyra |
Tier 3 - Non-Preferred Brand | — | — | ✓ | QL |
Medicare Part D
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Troy Medicare (HMO) | Tier 5 - Specialty | ✓ | — | ✓ 224 per 14 days | PA | QL |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 224 per 14 days | PA | QL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 224 per 14 days | PA | QL |