mirabegron

Generic: Myrbetriq

25 mg, 50 mg — Extended Release Tablet

URINARY ANTISPASMODICS

Also known as: mirabegron tab er 24 hr 25 mg, 50 mg Mirabegron Er 25 Mg Tablet Mirabegron Er 50 Mg Tablet mirabegron tb24 25mg, 50mg Mirabegron ER Oral Tablet Extended Release mirabegron srer 8mg/ml; tb24 25mg, 50mg Myrbetriq mirabegron srer mirabegron srer 8mg/ml
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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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 23 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Elite Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Signature Expanded Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Signature Silver with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Signature Gold with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Complete Gold + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Signature Expanded Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Signature Silver + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Signature Gold + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Signature Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Signature Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze Tier 4 - Non-Preferred ✓ — — PA
Complete Gold Tier 4 - Non-Preferred ✓ — — PA
Clear Silver with $0 Insulin Options Tier 4 - Non-Preferred ✓ — — PA
Signature Expanded Bronze Tier 4 - Non-Preferred ✓ — — PA
Signature Silver Tier 4 - Non-Preferred ✓ — — PA
Signature Gold Tier 4 - Non-Preferred ✓ — — PA
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Clear Silver with $0 Insulin Options + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Streamlined Silver Tier 4 - Non-Preferred ✓ — — PA
Streamlined Silver with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Enhanced CHF Heart Care Silver $0 Rx Options Tier 4 - Non-Preferred ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 23 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Premier + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Myrbetriq 		Tier 4 - Non-Preferred — — ✓ QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 23 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026 Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026 Tier 1 - Generic — — — None
BCBS Federal Focus 2026 Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026
via Myrbetriq 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Myrbetriq 		Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 23 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026
via Myrbetriq 		Tier 3 - High Cost Brand — — ✓ QL
BCBSNC Blue Value 2026
via Myrbetriq 		Tier 3 - High Cost Brand — — ✓ QL
BCBSNC Blue Care 2026
via Myrbetriq 		Tier 3 - High Cost Brand — — ✓ QL
BCBSNC Blue Local 2026
via Myrbetriq 		Tier 3 - High Cost Brand — — ✓ QL
BCBSNC Blue Advantage 2026
via Myrbetriq 		Tier 3 - High Cost Brand — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 23 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Myrbetriq 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Myrbetriq 		Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP)
via Myrbetriq 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP)
via Myrbetriq 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Myrbetriq 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
PruittHealth Premier (HMO I-SNP)
via Myrbetriq 		Tier 1 - Preferred Generic — — ✓ 30 per 30 days QL
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Myrbetriq 		Tier 1 - Preferred Generic — — — None
Wellcare Giveback Open (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Simple Open (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Liberty Open (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Assist Open (PPO) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Simple (HMO-POS) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Access (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Alignment Health Platinum Select (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED CORE 001 NC (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED GIVEBACK 002 NC (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED DUAL 009 NC (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED GIVEBACK 012 NC (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Signature (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Enhanced (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Enhanced (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Signature Extra (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Signature (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Signature (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Signature Giveback (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Signature (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Humana Full Access H5525-034 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
HumanaChoice Giveback H5525-035 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
HumanaChoice H5525-049 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
HumanaChoice H5525-050 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
HumanaChoice H5525-070 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Dual Select H5525-072 (PPO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
HumanaChoice H5525-083 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Erickson Advantage Signature (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Guardian (HMO-POS I-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Champion (HMO-POS C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Freedom (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Liberty (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
Liberty Medicare Advantage (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Humana Gold Plus H6622-025 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Gold Plus H6622-026 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Gold Plus H6622-057 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Gold Plus H6622-060 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Gold Plus H6622-061 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Alignment Health AVA (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
HealthSpring True Choice (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
Humana Gold Choice H8145-004 (PFFS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Healthy Blue + Medicare (HMO-POS D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED CHOICE 001 NC (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED CHOICE 003 NC (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED CHOICE 005 NC (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED CHOICE 008 NC (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
HealthSpring TotalCare (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Select (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Savings (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Plus (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Plan I (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Plan II (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Vitality Plan (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-137 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Gold Plus H1036-233 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Dual Select H1036-307 (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Humana Gold Plus H1036-335 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
UHC Dual Complete NC-S001 (PPO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S2 (PPO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Dual (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Signature (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Value Plus (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Prime (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Signature Care (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Enhanced (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Blue Medicare PPO Enhanced (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Blue Medicare Essential Plus (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Blue Medicare Enhanced (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Blue Medicare Choice (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Blue Medicare Essential (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Experience Health Medicare Advantage (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Senior Care (HMO I-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 30 per 30 days QL
Troy Medicare (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
HumanaChoice Giveback H5216-017 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
HumanaChoice H5216-211 (PPO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 30 days QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Alignment Health NC Duals (HMO-POS D-SNP)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Alignment Health smartHMO (HMO)
via Myrbetriq 		Tier 3 - Preferred Brand — — ✓ 300 per 28 days QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 23 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Myrbetriq 		Preferred — — — None
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 23 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - HDHP 2026
via mirabegron tb24 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via mirabegron tb24 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via mirabegron tb24 		Tier 2 - Non-Preferred Generic — — — None
Source: CMS QHP JSON  ·  Checked: 23 hours, 35 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Simple Diabetes | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Classic | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Classic 4700 | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Gold Classic Standard | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Classic Standard | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Classic Standard | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Gold Classic Standard Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Simple Chronic Care CKM | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Secure | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Classic 4700 | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Classic | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple Diabetes | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple PCP Saver | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Gold Elite Saver Plus | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Simple Diabetes | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple Chronic Care CKM | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
AIAN Cost Share
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
AIAN Cost Share | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple Diabetes Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Gold Elite Saver Plus Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple PCP Saver Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Classic 4700 Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Secure Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Classic Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Classic Standard Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Secure | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Classic Standard Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Simple Chronic Care CKM | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Gold Classic Standard | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Classic
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Secure
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Classic 4700
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple PCP Saver
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Gold Elite Saver Plus
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple Diabetes
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Classic Standard
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Classic Standard
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Gold Classic Standard
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Classic Standard | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
AIAN Cost Share | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Classic Standard | with Atrium Health
via Myrbetriq 		Tier 3 - Preferred Brand ✓ — ✓ PA | QL
AIAN Cost Share Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple Chronic Care CKM | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Bronze Simple Diabetes | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Gold Elite Saver Plus | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
Silver Simple PCP Saver | with Atrium Health Tier 3 - Preferred Brand ✓ — ✓ PA | QL
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