naproxen

Generic: Naprosyn

250mg, 375mg, 500mg — Tablet

ANALGESICS - ANTI-INFLAMMATORY

Also known as: naproxen oral suspension naproxen oral tablet naproxen oral tablet delayed release Naprosyn naproxen susp 125mg/5ml naproxen tabs 250mg, 375mg, 500mg; tbec 375mg, 500mg naproxen tab 250 mg, 375 mg naproxen tab 500 mg Naproxen 500 Mg Kit Naproxen 250 Mg Tablet Naproxen 375 Mg Tablet Naproxen 500 Mg Tablet Naproxen Dr 375 Mg Tablet Naproxen Dr 500 Mg Tablet naproxen susp 125mg/5ml; tabs 250mg, 375mg, 500mg; tbec 375mg, 500mg naproxen tabs 250mg, 375mg, 500mg; tbec Naproxen Oral Tablet

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: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Everyday Bronze Tier 2 - Generic QL
Complete Gold Tier 2 - Generic QL
Focused Silver with Atrium Health Tier 2 - Generic QL
Complete Gold with Atrium Health Tier 2 - Generic QL
Standard Expanded Bronze with Atrium Health Tier 2 - Generic QL
Standard Silver with Atrium Health Tier 2 - Generic QL
Elite Bronze + Vision + Adult Dental Tier 2 - Generic QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic QL
Standard Expanded Bronze + Vision + Adult Dental Tier 2 - Generic QL
Standard Silver + Vision + Adult Dental Tier 2 - Generic QL
Standard Gold + Vision + Adult Dental Tier 2 - Generic QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic QL
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic QL
Complete Gold + Vision + Adult Dental Tier 2 - Generic QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 2 - Generic QL
Standard Gold with Atrium Health Tier 2 - Generic QL
Elite Bronze with Atrium Health Tier 2 - Generic QL
Everyday Bronze with Atrium Health Tier 2 - Generic QL
Standard Gold Tier 2 - Generic QL
Standard Silver Tier 2 - Generic QL
Standard Expanded Bronze Tier 2 - Generic QL
Clear Silver with $0 Insulin Options Tier 2 - Generic QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 2 - Generic QL
Elite Bronze Tier 2 - Generic QL
Source: CMS QHP JSON  ·  Checked: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Signature + No Referrals
via Naprosyn
Tier 2 - Generic None
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Naprosyn
Tier 2 - Generic None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Naprosyn
Tier 2 - Generic None
AmeriHealth Caritas Next Gold Signature + No Referrals
via Naprosyn
Tier 2 - Generic None
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Naprosyn
Tier 2 - Generic None
AmeriHealth Caritas Next Gold Premier + 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 Silver Essential + No Referrals Tier 2 - Generic None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 2 - Generic None
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 2 - Generic None
AmeriHealth Caritas Next Bronze Premier + 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
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 2 - Generic None
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Naprosyn
Tier 2 - Generic None
AmeriHealth Caritas Next Gold Premier + No Referrals
via Naprosyn
Tier 2 - Generic None
AmeriHealth Caritas Next Silver Essential + No Referrals
via Naprosyn
Tier 2 - Generic None
AmeriHealth Caritas Next Silver Premier + No Referrals
via Naprosyn
Tier 2 - Generic None
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Naprosyn
Tier 2 - Generic None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 1 - Generic None
BCBS Federal Standard Option 2026 Tier 1 - Generic None
BCBS Federal Focus 2026 Tier 1 - Generic None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026 Tier 1 - Lowest Cost Generic None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 1 - Lowest Cost Generic None
BCBSNC Blue Value 2026
via Naprosyn
Tier 1 - Lowest Cost Generic None
BCBSNC Blue Care 2026
via Naprosyn
Tier 1 - Lowest Cost Generic None
BCBSNC Blue Local 2026
via Naprosyn
Tier 1 - Lowest Cost Generic None
BCBSNC Blue Home with UNC Health Alliance 2026
via Naprosyn
Tier 1 - Lowest Cost Generic None
BCBSNC Blue Advantage 2026
via Naprosyn
Tier 1 - Lowest Cost Generic None
BCBSNC Blue Value 2026 Tier 1 - Lowest Cost Generic None
BCBSNC Blue Care 2026 Tier 1 - Lowest Cost Generic None
BCBSNC Blue Advantage 2026 Tier 1 - Lowest Cost Generic None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver 3500 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect myDiabetesCare Silver Tier 1 - Preferred Generic None
Connect Silver RD 2200 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect Gold 1500 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect myDiabetesCare Bronze Tier 1 - Preferred Generic None
Connect Bronze 5500 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect Bronze RD 6000 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect Bronze RD 5000 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect Silver RD 3500 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect Bronze 7000 HSA Indiv Med Deductible Tier 1 - Preferred Generic None
Connect Silver 4400 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect Silver RD 5000 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect Silver 3000 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect Bronze 6500 Indiv Med Deductible Tier 1 - Preferred Generic None
Connect Silver CMS Standard Tier 2 - Generic None
Connect Bronze CMS Standard Tier 2 - Generic None
Connect Gold RD CMS Standard Tier 2 - Generic None
Connect Bronze RD CMS Standard Tier 2 - Generic None
Connect Gold CMS Standard Tier 2 - Generic None
Connect Silver RD CMS Standard Tier 2 - Generic None
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Humana Gold Plus H6622-025 (HMO-POS) 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
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 1 - Preferred Generic None
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 1 - Preferred Generic None
Erickson Advantage Liberty (HMO-POS) Tier 1 - Preferred Generic None
Erickson Advantage Freedom (HMO-POS) Tier 1 - Preferred Generic None
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 1 - Preferred Generic None
Erickson Advantage Signature (HMO-POS) Tier 1 - Preferred Generic None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 1 - Preferred Generic None
AARP Medicare Advantage from UHC NC-24 (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-0015 (HMO-POS) 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
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
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 1 - Preferred Generic None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 1 - Preferred Generic None
Wellcare Assist Open (PPO) Tier 1 - Preferred Generic None
Wellcare Dual Access (HMO-POS D-SNP) Tier 1 - Preferred Generic None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 1 - Preferred Generic None
Wellcare Dual Reserve (HMO-POS 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
Humana Gold Plus H1036-335 (HMO-POS) 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 H6622-026 (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
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 1 - Preferred Generic None
Senior Care (HMO I-SNP) 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-0007 (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-0021 (HMO-POS) Tier 1 - Preferred Generic None
AARP Medicare Advantage from UHC NC-0019 (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-0016 (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-0001 (PPO) Tier 1 - Preferred Generic None
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 1 - Preferred Generic None
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 1 - Preferred Generic None
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 1 - Preferred Generic None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 1 - Preferred Generic None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 1 - Preferred Generic None
AARP Medicare Advantage Giveback from UHC NC-14 (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 from UHC NC-0012 (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-0009 (HMO-POS) Tier 1 - Preferred Generic None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 1 - Preferred Generic None
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic None
Erickson Advantage Champion (HMO-POS C-SNP) Tier 1 - Preferred Generic None
UHC Complete Care NC-28 (HMO-POS C-SNP) 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
Troy Medicare (HMO) Tier 2 - Generic None
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) 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
HealthSpring Preferred Savings (HMO) Tier 3 - Preferred Brand None
HealthSpring Preferred (HMO) Tier 3 - Preferred Brand None
HealthSpring Preferred Select (HMO) Tier 3 - Preferred Brand None
HealthSpring Preferred Plus (HMO) Tier 3 - Preferred Brand None
HealthSpring True Choice (PPO) Tier 3 - Preferred Brand None
Blue Medicare Essential Plus (HMO-POS) Tier 4 - Non-Preferred 1800 per 30 days QL
Blue Medicare Enhanced (HMO-POS) Tier 4 - Non-Preferred 1800 per 30 days QL
Blue Medicare Choice (HMO) Tier 4 - Non-Preferred 1800 per 30 days QL
Blue Medicare Essential (HMO) Tier 4 - Non-Preferred 1800 per 30 days QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 4 - Non-Preferred 1800 per 30 days QL
Alignment Health Platinum (HMO) Tier 4 - Non-Preferred 1800 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP) Tier 4 - Non-Preferred 1800 per 30 days QL
Alignment Health smartHMO (HMO) Tier 4 - Non-Preferred 1800 per 30 days QL
Experience Health Medicare Advantage (HMO) Tier 4 - Non-Preferred 1800 per 30 days QL
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Signature Extra (PPO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Signature Giveback (PPO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Chronic Care (HMO C-SNP) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 4 - Non-Preferred 1800 per 30 days QL
Alignment Health Platinum Select (HMO) Tier 4 - Non-Preferred 1800 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 4 - Non-Preferred 1800 per 30 days QL
Alignment Health AVA (PPO) Tier 4 - Non-Preferred 1800 per 30 days QL
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Dual (HMO D-SNP) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Enhanced (HMO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Signature Care (HMO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Prime (HMO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Value Plus (HMO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred 1800 per 30 days PA | QL
Blue Medicare PPO Enhanced (PPO) Tier 4 - Non-Preferred 1800 per 30 days QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred None
NC Medicaid Preferred Drug List 2026
via Naprosyn
Non-Preferred None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic None
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
Source: CMS QHP JSON  ·  Checked: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 1 - Preferred Generic None
Bronze Simple Chronic Care CKM | with Atrium Health Tier 1 - Preferred Generic None
Bronze Simple Diabetes | with Atrium Health Tier 1 - Preferred Generic None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 1 - Preferred Generic None
Silver Simple Chronic Care CKM | with Atrium Health Tier 1 - Preferred Generic None
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 1 - Preferred Generic None
AIAN Cost Share Tier 1 - Preferred Generic None
AIAN Cost Share | with Atrium Health Tier 1 - Preferred Generic None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 1 - Preferred Generic None
Silver Classic | with Atrium Health Tier 1 - Preferred Generic None
Silver Simple Diabetes | with Atrium Health Tier 1 - Preferred Generic None
Silver Simple PCP Saver | with Atrium Health Tier 1 - Preferred Generic None
Gold Elite Saver Plus | with Atrium Health Tier 1 - Preferred Generic None
Bronze Elite + PCP Saver Plus Tier 1 - Preferred Generic None
Silver Classic Tier 1 - Preferred Generic None
Secure Tier 1 - Preferred Generic None
Bronze Classic 4700 Tier 1 - Preferred Generic None
Silver Simple PCP Saver Tier 1 - Preferred Generic None
Gold Elite Saver Plus Tier 1 - Preferred Generic None
Silver Simple Diabetes Tier 1 - Preferred Generic None
Secure | with Atrium Health Tier 1 - Preferred Generic None
Bronze Classic 4700 | with Atrium Health Tier 1 - Preferred Generic None
Bronze Classic Standard | with Atrium Health Tier 2 - Generic None
Silver Classic Standard Tier 2 - Generic None
Bronze Classic Standard Tier 2 - Generic None
Silver Classic Standard | with Atrium Health Tier 2 - Generic None
Gold Classic Standard | with Atrium Health Tier 2 - Generic None
Gold Classic Standard Tier 2 - Generic None
Source: Excel (XLSX)  ·  Formulary date: Jun 24, 2026  ·  Checked: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Basic Core Formulary None
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 21 hours, 44 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 1 - Preferred Generic None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 1 - Preferred Generic None
UHC Gold Standard (No Referrals) Tier 1 - Preferred Generic None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 1 - Preferred Generic None
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 1 - Preferred Generic None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 1 - Preferred Generic None
UHC Bronze Standard (No Referrals) Tier 1 - Preferred Generic None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 1 - Preferred Generic None
UHC Silver Standard (No Referrals) Tier 1 - Preferred Generic None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 1 - Preferred Generic None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 1 - Preferred Generic None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 1 - Preferred Generic None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 1 - Preferred Generic None
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