MVC-Fluoride

Generic: ascorbic acid

60 MG — Chewable Tablet

Also known as: ascorbic acid
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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: 8 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Silver with Atrium Health + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Gold with Atrium Health + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options
via ascorbic acid 		Tier 2 - Generic — — — None
Complete Gold
via ascorbic acid 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via ascorbic acid 		Tier 2 - Generic — — — None
Everyday Bronze
via ascorbic acid 		Tier 2 - Generic — — — None
Elite Bronze
via ascorbic acid 		Tier 2 - Generic — — — None
Complete Gold + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Gold with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Silver with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Expanded Bronze with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Gold
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Silver
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Expanded Bronze
via ascorbic acid 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Elite Bronze + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Silver + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Expanded Bronze + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Everyday Bronze + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Gold + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via ascorbic acid 		Tier 2 - Generic — — — None
Source: CMS QHP JSON  ·  Checked: 8 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Signature + No Referrals
via ascorbic acid 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Essential + No Referrals
via ascorbic acid 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals
via ascorbic acid 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Bronze Premier + No Referrals
via ascorbic acid 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via ascorbic acid 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Gold Signature + No Referrals
via ascorbic acid 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + No Referrals
via ascorbic acid 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals
via ascorbic acid 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via ascorbic acid 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Gold Premier + No Referrals
via ascorbic acid 		Tier 2 - Generic ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 8 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via Moviprep 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Moviprep 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Plenvu 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Plenvu 		Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: Jun 1, 2026  ·  Checked: 8 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Care 2026
via Moviprep 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Moviprep 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Local 2026
via Moviprep 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Value 2026
via Moviprep 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Advantage 2026
via Moviprep 		Tier 2 - Medium Cost Generic/Brand — — — None
Source: CMS QHP JSON  ·  Formulary date: May 13, 2026  ·  Checked: 8 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
PruittHealth Premier (HMO I-SNP)
via ascorbic acid 		Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP)
via ascorbic acid 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via ascorbic acid 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP)
via ascorbic acid 		Tier 1 - Preferred Generic — — — None
Senior Care (HMO I-SNP)
via ascorbic acid 		Tier 2 - Generic — — — None
Liberty Medicare Advantage (HMO C-SNP)
via ascorbic acid 		Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via ascorbic acid 		Tier 3 - Preferred Brand — — — None
Alignment Health AVA (PPO)
via ascorbic acid 		Tier 3 - Preferred Brand — — — None
Wellcare Dual Liberty Open (PPO D-SNP)
via Plenvu 		Tier 3 - Preferred Brand — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via ascorbic acid 		Tier 3 - Preferred Brand — — — None
Alignment Health smartHMO (HMO)
via ascorbic acid 		Tier 3 - Preferred Brand — — — None
Alignment Health NC Duals (HMO-POS D-SNP)
via ascorbic acid 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum (HMO)
via ascorbic acid 		Tier 3 - Preferred Brand — — — None
Wellcare Assist Open (PPO)
via Plenvu 		Tier 3 - Preferred Brand — — — None
Wellcare Dual Access (HMO-POS D-SNP)
via Plenvu 		Tier 3 - Preferred Brand — — — None
Wellcare Dual Reserve (HMO-POS D-SNP)
via Plenvu 		Tier 3 - Preferred Brand — — — None
Wellcare Dual Liberty (HMO-POS D-SNP)
via Plenvu 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum Select (HMO)
via ascorbic acid 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (HMO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Dual (HMO D-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (HMO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Value Plus (HMO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Prime (HMO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature Care (HMO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Full Dual Care (HMO D-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (HMO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature Extra (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature Giveback (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Chronic Care (HMO C-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED DUAL 009 NC (HMO D-SNP)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED CORE 001 NC (HMO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED GIVEBACK 002 NC (HMO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED GIVEBACK 012 NC (HMO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 001 NC (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 003 NC (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 005 NC (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 008 NC (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Wellcare Simple Open (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Wellcare Simple (HMO-POS)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Wellcare Giveback Open (PPO)
via Plenvu 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 8 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026
via Moviprep 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Moviprep 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Moviprep 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Plenvu 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Plenvu 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Plenvu 		Not Covered — — — None
Source: CMS QHP JSON  ·  Checked: 8 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Simple PCP Saver | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Silver Classic | with Atrium Health Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health Tier 2 - Generic — — — None
Secure | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Diabetes Tier 2 - Generic — — — None
Gold Elite Saver Plus Tier 2 - Generic — — — None
Silver Simple PCP Saver Tier 2 - Generic — — — None
Bronze Classic 4700 Tier 2 - Generic — — — None
Secure Tier 2 - Generic — — — None
Silver Classic Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Gold Classic Standard Tier 2 - Generic — — — None
Silver Classic Standard Tier 2 - Generic — — — None
Bronze Classic Standard Tier 2 - Generic — — — None
Gold Elite Saver Plus
via ascorbic acid 		Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Gold Elite Saver Plus | with Atrium Health Tier 2 - Generic — — — None
Gold Classic Standard
via ascorbic acid 		Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus
via ascorbic acid 		Tier 2 - Generic — — — None
Silver Classic
via ascorbic acid 		Tier 2 - Generic — — — None
Secure
via ascorbic acid 		Tier 2 - Generic — — — None
Bronze Classic 4700
via ascorbic acid 		Tier 2 - Generic — — — None
Silver Simple PCP Saver
via ascorbic acid 		Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Diabetes
via ascorbic acid 		Tier 2 - Generic — — — None
Secure | with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Silver Classic | with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
Gold Elite Saver Plus | with Atrium Health
via ascorbic acid 		Tier 2 - Generic — — — None
AIAN Cost Share | with Atrium Health Tier 2 - Generic — — — None
AIAN Cost Share Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 2 - Generic — — — None
Bronze Classic Standard
via ascorbic acid 		Tier 2 - Generic — — — None
Silver Classic Standard
via ascorbic acid 		Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via ascorbic acid 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Diabetes | with Atrium Health
via ascorbic acid 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via ascorbic acid 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Chronic Care CKM | with Atrium Health
via ascorbic acid 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via ascorbic acid 		Tier 3 - Preferred Brand — — ✓ QL
AIAN Cost Share
via ascorbic acid 		Tier 3 - Preferred Brand — — ✓ QL
AIAN Cost Share | with Atrium Health
via ascorbic acid 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via ascorbic acid 		Tier 3 - Preferred Brand — — ✓ QL
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 8 hours, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Bronze Standard (No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Silver Standard (No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Bronze Standard+ Dental + Vision (No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
UHC Gold Standard (No Referrals)
via ascorbic acid 		Tier 4 - Non-Preferred — — ✓ QL
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