lovastatin
20 mg, 40 mg, 60 mg — Tablet
Also known as:
lovastatin oral
Mevacor
lovastatin tabs 10mg, 20mg, 40mg
lovastatin tab 10 mg
lovastatin tab 20 mg, 40 mg
Lovastatin 10 Mg Tablet
Lovastatin 20 Mg Tablet
Lovastatin 40 Mg Tablet
ALTOPREV
Lovastatin Oral Tablet
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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)
34 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Signature Silver with Atrium Health + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Gold with Atrium Health + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Expanded Bronze | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Elite Bronze | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Everyday Bronze | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver $0 Rx Options | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Complete Gold | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Streamlined Silver with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Streamlined Silver | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Elite Bronze + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Expanded Bronze + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Silver + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Gold + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Gold with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Silver with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Gold | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Silver | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Complete Gold + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Signature Expanded Bronze with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Enhanced CHF Heart Care Silver $0 Rx Options | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options + Vision + Adult Dental | Tier 1 - Preferred Generic | — | — | ✓ | QL |
AmeriHealth Caritas NC
11 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — NCTM | None |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — NCTM | None |
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | — NCTM | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Care 2026 | Tier 1 - Lowest Cost Generic | — | — | — | None |
| BCBSNC Blue Local 2026 | Tier 1 - Lowest Cost Generic | — | — | — | None |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 1 - Lowest Cost Generic | — | — | — | None |
| BCBSNC Blue Advantage 2026 | Tier 1 - Lowest Cost Generic | — | — | — | None |
| BCBSNC Blue Value 2026 | Tier 1 - Lowest Cost Generic | — | — | — | None |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Gold 1500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze 5500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze 6500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver 3000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver 5000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver 3600 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect myDiabetesCare Bronze | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect myDiabetesCare Silver | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 1 - Preferred Generic | — | — | — | None |
| Connect Bronze RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Gold CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Gold RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD CMS Standard | Tier 2 - Generic | — | — | — | None |
Medicare Part D
140 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| HumanaChoice H5525-083 (PPO) | 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 Champion (HMO-POS C-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 |
| 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 Advantage (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Dual Plan (HMO D-SNP) | 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 |
| HealthSpring True Choice (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Choice H8145-004 (PFFS) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED CHOICE 001 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE 003 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE 005 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| DEVOTED CHOICE 008 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring TotalCare (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring Preferred (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring Preferred Select (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring Preferred Savings (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| HealthSpring Preferred Plus (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| 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 |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| UHC Nursing Home Plan NC-F001 (PPO 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 |
| 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 |
| Aetna Medicare Signature (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Value Plus (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Prime (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Signature Care (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Enhanced (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Senior Care (HMO I-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 |
| Troy Medicare (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| HumanaChoice H5216-211 (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 |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | 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 |
| DEVOTED CORE 001 NC (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Signature Extra (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Signature Giveback (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Signature (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 |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Alignment Health Platinum Select (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Alignment Health smartHMO (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Alignment Health Platinum (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Wellcare Assist Open (PPO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Wellcare Giveback Open (PPO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
| Blue Medicare PPO Enhanced (PPO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Blue Medicare Essential Plus (HMO-POS) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Blue Medicare Enhanced (HMO-POS) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Blue Medicare Choice (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Blue Medicare Essential (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Experience Health Medicare Advantage (HMO) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
| Wellcare Simple (HMO-POS) | Tier 6 - Specialty Plus | — | — | ✓ 60 per 30 days | QL |
NC Medicaid PDL
2 plansNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Bronze Classic 4700 | Tier 1 - Preferred Generic | — | — | — | None |
| Silver Simple PCP Saver | Tier 1 - Preferred Generic | — | — | — | None |
| Gold Elite Saver Plus | Tier 1 - Preferred Generic | — | — | — | None |
| Silver Simple Diabetes | Tier 1 - Preferred Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 1 - Preferred Generic | — | — | — | None |
| Silver Classic | Tier 1 - Preferred Generic | — | — | — | None |
| Secure | 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 |
| Secure | with Atrium Health | Tier 1 - Preferred Generic | — | — | — | None |
| 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 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 |
| Silver Classic Standard | Tier 2 - Generic | — | — | — | None |
| Bronze 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 |
| Gold Classic Standard | Tier 2 - Generic | — | — | — | None |
TRICARE
1 planUnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, 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, HSA, $0 Insulin, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Standard (HSA, $0 Insulin, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, 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 Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |