nifedipine

Generic: nifedipine er osmotic release

30 mg, 60 mg, 90 mg — Capsule

ANTIANGINAL AGENTS

Also known as: nifedipine er osmotic release nifedipine oral Procardia Adalat CC nifedipine caps 10mg, 20mg; tb24 30mg, 60mg, 90mg nifedipine tab er 24hr 30 mg, 60 mg, 90 mg nifedipine tab er 24hr osmotic release 30 mg, 60 mg, 90 mg nifedipine cap 10 mg, 20 mg Nifedipine 10 Mg Capsule Nifedipine 20 Mg Capsule Nifedipine Er 30 Mg Tablet Nifedipine Er 60 Mg Tablet Nifedipine Er 90 Mg Tablet NIFEDIPINE ER nifedipine caps 10mg, 20mg; tb24 30mg, NIFEdipine ER Osmotic Release Oral Tablet Extended Release NIFEdipine Oral Capsule NIFEdipine ER Oral Tablet Extended Release
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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: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze Tier 2 - Generic — — ✓ QL
Signature Gold Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Signature Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Signature Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Complete Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Elite Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options Tier 2 - Generic — — ✓ QL
Elite Bronze Tier 2 - Generic — — ✓ QL
Everyday Bronze Tier 2 - Generic — — ✓ QL
Streamlined Silver Tier 2 - Generic — — ✓ QL
Streamlined Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Enhanced CHF Heart Care Silver $0 Rx Options Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver $0 Rx Options Tier 2 - Generic — — ✓ QL
Complete Gold Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Silver + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Silver Tier 2 - Generic — — ✓ QL
Signature Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 22 hours, 41 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 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 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 Signature + 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 Bronze 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 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 Silver Premier + No Referrals Tier 1 - Preferred 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 Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026 Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026 Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026 Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026
via Procardia XL 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Procardia XL 		Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Procardia XL 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Procardia XL 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Procardia XL 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Procardia XL 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Procardia XL 		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 Home with UNC Health Alliance 2026 Tier 1 - Lowest Cost Generic — — — None
Source: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Gold CMS Standard Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard
via nifedipine er 		Tier 2 - Generic — — — None
Connect Silver CMS Standard
via nifedipine er 		Tier 2 - Generic — — — None
Connect Bronze CMS Standard
via nifedipine er 		Tier 2 - Generic — — — None
Connect Gold RD CMS Standard
via nifedipine er 		Tier 2 - Generic — — — None
Connect Silver RD CMS Standard
via nifedipine er 		Tier 2 - Generic — — — None
Connect Gold CMS Standard
via nifedipine er 		Tier 2 - Generic — — — None
Connect Silver CMS Standard Tier 2 - Generic — — — None
Connect Gold RD CMS Standard Tier 2 - Generic — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect Bronze 6500 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect Silver 5000 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect myDiabetesCare Silver
via nifedipine er 		Tier 2 - Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect Bronze 5500 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect Silver 3000 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect myDiabetesCare Bronze
via nifedipine er 		Tier 2 - Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect Silver 3600 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect Gold 1500 Indiv Med Deductible
via nifedipine er 		Tier 2 - Generic — — — None
Connect Bronze 7000 HSA Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze RD 6000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze 6500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect myDiabetesCare Silver Tier 2 - Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze 5500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 3000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect myDiabetesCare Bronze Tier 2 - Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 3600 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Gold 1500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard Tier 2 - Generic — — — None
Connect Silver RD CMS Standard Tier 2 - Generic — — — None
Connect Bronze CMS Standard Tier 2 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Troy Medicare (HMO)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-S001 (PPO D-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S2 (PPO D-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0001 (PPO)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0004 (PPO)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0016 (PPO)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0017 (PPO)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0019 (PPO)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Signature (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Guardian (HMO-POS I-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
Aetna Medicare Chronic Care (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via nifedipine er 		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
Senior Care (HMO I-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
Senior Care (HMO I-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Liberty (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Freedom (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Complete Care NC-25 (HMO-POS C-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Complete Care NC-27 (HMO-POS C-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Complete Care NC-28 (HMO-POS C-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Champion (HMO-POS C-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Champion (HMO-POS C-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Signature (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Liberty (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Erickson Advantage Freedom (HMO-POS)
via nifedipine er 		Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Liberty Medicare Advantage (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage (HMO C-SNP)
via nifedipine er 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Aetna Medicare Full Dual Care (HMO D-SNP)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Dual (HMO D-SNP)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Value Plus (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Prime (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Signature Care (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Signature Extra (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Signature Giveback (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO) Tier 2 - Generic — — — None
Aetna Medicare Dual (HMO D-SNP) Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO) Tier 2 - Generic — — — None
Aetna Medicare Value Plus (HMO) Tier 2 - Generic — — — None
Aetna Medicare Prime (HMO) Tier 2 - Generic — — — None
Aetna Medicare Signature Care (HMO) Tier 2 - Generic — — — None
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (HMO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature Extra (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature Giveback (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Wellcare Simple Open (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Wellcare Simple (HMO-POS)
via nifedipine er 		Tier 2 - Generic — — — None
Wellcare Simple Open (PPO) Tier 2 - Generic — — — None
Wellcare Simple (HMO-POS) Tier 2 - Generic — — — None
Wellcare Giveback Open (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Wellcare Giveback Open (PPO) Tier 2 - Generic — — — None
Blue Medicare PPO Enhanced (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Blue Medicare Essential Plus (HMO-POS)
via nifedipine er 		Tier 2 - Generic — — — None
Blue Medicare Enhanced (HMO-POS)
via nifedipine er 		Tier 2 - Generic — — — None
Blue Medicare Choice (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Blue Medicare Essential (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Experience Health Medicare Advantage (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Healthy Blue + Medicare (HMO-POS D-SNP)
via nifedipine er 		Tier 2 - Generic — — — None
Blue Medicare PPO Enhanced (PPO) Tier 2 - Generic — — — None
Blue Medicare Essential Plus (HMO-POS) Tier 2 - Generic — — — None
Blue Medicare Enhanced (HMO-POS) Tier 2 - Generic — — — None
Blue Medicare Choice (HMO) Tier 2 - Generic — — — None
Blue Medicare Essential (HMO) Tier 2 - Generic — — — None
Experience Health Medicare Advantage (HMO) Tier 2 - Generic — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 2 - Generic — — — None
Alignment Health Platinum (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Alignment Health NC Duals (HMO-POS D-SNP)
via nifedipine er 		Tier 2 - Generic — — — None
Alignment Health smartHMO (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via nifedipine er 		Tier 2 - Generic — — — None
Alignment Health Platinum Select (HMO)
via nifedipine er 		Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via nifedipine er 		Tier 2 - Generic — — — None
Alignment Health AVA (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Alignment Health Platinum (HMO) Tier 2 - Generic — — — None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 2 - Generic — — — None
Alignment Health smartHMO (HMO) Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 2 - Generic — — — None
Alignment Health Platinum Select (HMO) Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 2 - Generic — — — None
Alignment Health AVA (PPO) Tier 2 - Generic — — — None
HealthTeam Advantage Plan I (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
HealthTeam Advantage Plan II (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
HealthTeam Advantage Vitality Plan (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
HealthTeam Advantage Plan I (PPO) Tier 2 - Generic — — — None
HealthTeam Advantage Plan II (PPO) Tier 2 - Generic — — — None
HealthTeam Advantage Vitality Plan (PPO) Tier 2 - Generic — — — None
Troy Medicare (HMO) Tier 2 - Generic ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic ✓ — — PA
Wellcare Dual Liberty Open (PPO D-SNP)
via nifedipine er 		Tier 2 - Generic — — — None
Wellcare Assist Open (PPO)
via nifedipine er 		Tier 2 - Generic — — — None
Wellcare Dual Access (HMO-POS D-SNP)
via nifedipine er 		Tier 2 - Generic — — — None
Wellcare Dual Liberty (HMO-POS D-SNP)
via nifedipine er 		Tier 2 - Generic — — — None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 2 - Generic — — — None
Wellcare Assist Open (PPO) Tier 2 - Generic — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 2 - Generic — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 2 - Generic — — — None
Wellcare Dual Reserve (HMO-POS D-SNP)
via nifedipine er 		Tier 2 - Generic — — — None
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 2 - Generic — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 3 - Preferred Brand — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 008 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 005 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 003 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 001 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 008 NC (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 005 NC (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 003 NC (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 001 NC (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 012 NC (HMO) Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 002 NC (HMO) Tier 3 - Preferred Brand — — — None
DEVOTED CORE 001 NC (HMO) Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 012 NC (HMO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 002 NC (HMO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED CORE 001 NC (HMO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Plus (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Savings (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Select (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Plus (HMO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Savings (HMO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Select (HMO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HealthSpring Preferred (HMO)
via nifedipine er 		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 TotalCare Plus (HMO D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HealthSpring True Choice (PPO) Tier 3 - Preferred Brand — — — None
HealthSpring True Choice (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-137 (HMO-POS)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-233 (HMO-POS)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H1036-307 (HMO D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-335 (HMO-POS)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5216-017 (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5216-211 (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Full Access H5525-034 (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5525-035 (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-049 (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-050 (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-070 (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H5525-072 (PPO D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-083 (PPO)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-025 (HMO-POS)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-026 (HMO-POS)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-057 (HMO-POS)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-060 (HMO-POS)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-061 (HMO-POS)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Choice H8145-004 (PFFS)
via nifedipine er 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-137 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-233 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Dual Select H1036-307 (HMO D-SNP) Tier 3 - Preferred Brand — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-335 (HMO-POS) Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5216-017 (PPO) Tier 3 - Preferred Brand — — — None
HumanaChoice H5216-211 (PPO) Tier 3 - Preferred Brand — — — None
Humana Full Access H5525-034 (PPO) Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5525-035 (PPO) Tier 3 - Preferred Brand — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-049 (PPO) Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-050 (PPO) Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-070 (PPO) Tier 3 - Preferred Brand — — — None
Humana Dual Select H5525-072 (PPO D-SNP) Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-083 (PPO) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-025 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-026 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-057 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-060 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-061 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Choice H8145-004 (PFFS) Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via nifedipine er 		Tier 6 - Specialty Plus — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 6 - Specialty Plus — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Preferred — — — None
NC Medicaid Preferred Drug List 2026
via Procardia XL 		Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 22 hours, 41 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 - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic — — — None
Source: CMS QHP JSON  ·  Checked: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Secure Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 2 - Generic — — — None
AIAN Cost Share Tier 2 - Generic — — — None
AIAN Cost Share | with Atrium Health Tier 2 - Generic — — — None
Bronze Classic 4700 Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health 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 | with Atrium Health Tier 2 - Generic — — — None
Silver Simple PCP Saver | 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 Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Source: Excel (XLSX)  ·  Formulary date: Jul 31, 2026  ·  Checked: 22 hours, 41 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: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic — — ✓ QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 1 - Preferred Generic — — ✓ QL
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 1 - Preferred Generic — — ✓ QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 1 - Preferred Generic — — ✓ QL
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic — — ✓ QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 1 - Preferred Generic — — ✓ QL
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic — — — None
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