metoprolol succinate
25 mg, 50 mg, 100 mg, 200 mg — Extended Release Tablet
Also known as:
metoprolol succinate tab er 24hr 25 mg (tartrate equiv), 50 mg (tartrate equiv), 100 mg (tartrate equiv), 200 mg (tartrate equiv)
Metoprolol Succinate Er 25 Mg Tablet
Metoprolol Succinate Er 50 Mg Tablet
Metoprolol Succinate Er 100 Mg Tablet
Metoprolol Succinate Er 200 Mg Tablet
metoprolol succinate tb24 25mg, 50mg, 100mg, 200mg
TOPROL XL
Metoprolol Succinate ER Oral Tablet Extended Release
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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 |
|---|---|---|---|---|---|
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Elite Bronze | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | — | None |
| Standard Gold | Tier 2 - Generic | — | — | — | None |
| Standard Silver | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Toprol XL |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Toprol XL |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Care 2026
via Toprol XL |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Local 2026
via Toprol XL |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Toprol XL |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Toprol XL |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Value 2026
via Toprol XL |
Tier 1 - Lowest Cost Generic | — | — | — | None |
Medicare Part D
140 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| HealthSpring Preferred (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| HealthSpring Preferred Select (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| HealthSpring Preferred Savings (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| HealthSpring Preferred Plus (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED CORE 001 NC (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED CHOICE 001 NC (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED CHOICE 003 NC (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED CHOICE 005 NC (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED CHOICE 008 NC (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| NHC Advantage (HMO I-SNP) | 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 Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Wellcare Simple (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| Wellcare Giveback Open (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Blue Medicare PPO Enhanced (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Blue Medicare Essential Plus (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| Blue Medicare Enhanced (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| Blue Medicare Choice (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Blue Medicare Essential (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Experience Health Medicare Advantage (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health Platinum (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health smartHMO (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health Platinum Select (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| 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 |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | 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 |
| 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 |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | 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 Freedom (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| Erickson Advantage Liberty (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | 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 |
| Erickson Advantage Champion (HMO-POS C-SNP) | 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 Enhanced (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| 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 |
| Troy Medicare (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-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 |
| 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 |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| HumanaChoice H5216-211 (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 |
| HumanaChoice H5525-083 (PPO) | 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 |
| Humana Gold Choice H8145-004 (PFFS) | Tier 1 - Preferred Generic | — | — | — | None |
| Senior Care (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Assist Open (PPO) | Tier 2 - Generic | — | — | — | None |
| HealthSpring TotalCare (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 6 - Specialty Plus | — | — | — | None |
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
via metoprolol succinate tb24 |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via metoprolol succinate tb24 |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via metoprolol succinate tb24 |
Tier 1 - Preferred Generic | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Bronze Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| AIAN Cost Share | Tier 2 - Generic | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | Tier 2 - Generic | — | — | — | None |
| Secure | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | Tier 2 - Generic | — | — | — | None |
| Gold 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 |
| Bronze Elite + PCP Saver Plus | Tier 2 - Generic | — | — | — | None |
| Silver Classic | Tier 2 - Generic | — | — | — | None |
| Secure | Tier 2 - Generic | — | — | — | None |
TRICARE
1 planUnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Silver Standard (No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Gold Standard (No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Bronze Standard (No Referrals) | Tier 0 - $0 Preventive | — | — | — | None |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 0 - $0 Preventive | — | — | — | None |