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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 |
|---|---|---|---|---|---|
| Standard Expanded Bronze with Atrium Health | 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 |
| Clear Silver with $0 Insulin Options | 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 |
| Complete Gold | 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 |
| Focused Silver with Atrium Health + Vision + Adult Dental | 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 |
Medicare Part D
12 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| Troy Medicare (HMO) | Tier 2 - Generic | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Simple Open (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Assist Open (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Giveback Open (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Simple (HMO-POS) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
UnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Gold Standard (No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Bronze Standard (No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Silver Standard (No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | — | ✓ | ✓ | ST | QL |