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
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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: 21 hours, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Streamlined Silver Tier 2 - Generic — — ✓ QL
Signature Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Silver + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze 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
Complete Gold Tier 2 - Generic — — ✓ QL
Focused Silver 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
Signature Gold Tier 2 - Generic — — ✓ QL
Signature Silver Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze Tier 2 - Generic — — ✓ QL
Complete Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Enhanced CHF Heart Care Silver $0 Rx Options Tier 2 - Generic — — ✓ QL
Signature Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Elite Bronze Tier 2 - Generic — — ✓ QL
Everyday Bronze Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver $0 Rx Options Tier 2 - Generic — — ✓ QL
Streamlined Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 21 hours, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Naprosyn 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Naprosyn 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Naprosyn 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Naprosyn 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Naprosyn 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Naprosyn 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Naprosyn 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals
via Naprosyn 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Naprosyn 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Naprosyn 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 21 hours, 3 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: Oct 1, 2026  ·  Checked: 21 hours, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026
via Naprosyn 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Naprosyn 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 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 Value 2026
via Naprosyn 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Naprosyn 		Tier 1 - Lowest Cost Generic — — — None
Source: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 21 hours, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver 3600 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Silver 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 Bronze RD 6000 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Gold 1500 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect myDiabetesCare Silver Tier 1 - Preferred Generic — — — None
Connect myDiabetesCare Bronze 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 Bronze 5500 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Silver 5000 Indiv Med Deductible Tier 1 - Preferred Generic — — — None
Connect Gold RD CMS Standard Tier 2 - Generic — — — None
Connect Silver RD CMS Standard Tier 2 - Generic — — — None
Connect Silver CMS Standard Tier 2 - Generic — — — None
Connect Bronze CMS Standard Tier 2 - Generic — — — None
Connect Gold CMS Standard Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard Tier 2 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 21 hours, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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
HealthTeam Advantage Plan I (PPO) Tier 1 - Preferred Generic — — — None
HealthTeam Advantage Vitality Plan (PPO) Tier 1 - Preferred Generic — — — None
HealthTeam Advantage Plan II (PPO) Tier 1 - Preferred Generic — — — None
UHC Nursing Home Plan NC-F001 (PPO 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 - Diabetes and Heart (HMO C-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
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
Wellcare Simple Open (PPO) 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 Giveback Open (PPO) 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
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Wellcare Simple (HMO-POS) Tier 1 - Preferred Generic — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Senior Care (HMO I-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
HumanaChoice Giveback H5216-017 (PPO) Tier 1 - Preferred Generic — — — None
HumanaChoice H5216-211 (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
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) 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
DEVOTED CORE 001 NC (HMO) Tier 1 - Preferred Generic — — — None
DEVOTED GIVEBACK 002 NC (HMO) 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 GIVEBACK 012 NC (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
Longevity Health Plan (HMO I-SNP) 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
Erickson Advantage Signature (HMO-POS) Tier 1 - Preferred Generic — — — None
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 1 - Preferred Generic — — — None
Erickson Advantage Champion (HMO-POS C-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
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 Advantage (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP) 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
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 Preferred Select (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring True Choice (PPO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Plus (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Savings (HMO) Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (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 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 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 1800 per 30 days PA | QL
Alignment Health Heart & Diabetes Care (HMO 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 NCPlus (HMO-POS C-SNP) Tier 4 - Non-Preferred — — ✓ 1800 per 30 days QL
Alignment Health smartHMO (HMO) 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
Aetna Medicare Signature Care (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 Chronic Care (HMO C-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 Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 1800 per 30 days PA | QL
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
Experience Health Medicare Advantage (HMO) Tier 4 - Non-Preferred — — ✓ 1800 per 30 days QL
Blue Medicare PPO Enhanced (PPO) 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 (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 (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 Signature (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 Prime (HMO) Tier 4 - Non-Preferred ✓ — ✓ 1800 per 30 days PA | 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
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 21 hours, 3 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: Oct 1, 2026  ·  Checked: 21 hours, 3 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 - HDHP 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, 3 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Elite + PCP 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
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
Secure | with Atrium Health Tier 1 - Preferred Generic — — — None
Bronze Classic 4700 | 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 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
Silver Simple Women's Health with Menopause Benefits | 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 Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Silver Classic Standard Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Bronze Classic Standard Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Gold Classic Standard Tier 2 - Generic — — — None
Source: Excel (XLSX)  ·  Formulary date: Jul 31, 2026  ·  Checked: 21 hours, 2 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: Sep 23, 2026  ·  Checked: 21 hours, 2 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — — PA
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