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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.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via Mayzent Starter Pack |
Tier 2 - Preferred Brand | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Mayzent Starter Pack |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Mayzent Starter Pack |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Care 2026
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Value 2026
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Local 2026
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Advantage 2026
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Mayzent Starter Pack |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
Medicare Part D
16 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Mayzent Starter Pack |
Tier 1 - Preferred Generic | ✓ | — | ✓ 14 per 365 days | PA | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Mayzent Starter Pack |
Tier 1 - Preferred Generic | ✓ | — | ✓ 14 per 365 days | PA | QL |
|
PruittHealth Premier (HMO I-SNP)
via Mayzent Starter Pack |
Tier 1 - Preferred Generic | — | — | ✓ 7 per 28 days | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Mayzent Starter Pack |
Tier 1 - Preferred Generic | — | — | ✓ 7 per 28 days | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Mayzent Starter Pack |
Tier 1 - Preferred Generic | — | — | ✓ 7 per 28 days | QL |
|
NHC Advantage (HMO I-SNP)
via Mayzent Starter Pack |
Tier 1 - Preferred Generic | — | — | ✓ 7 per 28 days | QL |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Mayzent Starter Pack |
Tier 1 - Preferred Generic | ✓ | — | ✓ 14 per 365 days | PA | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via Mayzent Starter Pack |
Tier 3 - Preferred Brand | — | — | ✓ 7 per 28 days | QL |
|
Senior Care (HMO I-SNP)
via Mayzent Starter Pack |
Tier 3 - Preferred Brand | — | — | ✓ 7 per 28 days | QL |
|
HealthTeam Advantage Plan I (PPO)
via Mayzent Starter Pack |
Tier 4 - Non-Preferred | ✓ | — | ✓ 14 per 365 days | PA | QL |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Mayzent Starter Pack |
Tier 4 - Non-Preferred | ✓ | — | ✓ 14 per 365 days | PA | QL |
|
Troy Medicare (HMO)
via Mayzent Starter Pack |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Mayzent Starter Pack |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Mayzent Starter Pack |
Tier 4 - Non-Preferred | ✓ | — | ✓ 7 per 180 days | PA | QL |
|
HealthTeam Advantage Plan II (PPO)
via Mayzent Starter Pack |
Tier 4 - Non-Preferred | ✓ | — | ✓ 14 per 365 days | PA | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via Mayzent Starter Pack |
Tier 4 - Non-Preferred | ✓ | — | ✓ 14 per 365 days | PA | QL |
NC Medicaid PDL
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 5 - Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 5 - Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - HDHP 2026 | Tier 5 - Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |