Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver 4400 Indiv Med Deductible Tier 2 - Generic QL
Connect Bronze CMS Standard Tier 2 - Generic QL
Connect Gold RD CMS Standard Tier 2 - Generic QL
Connect Bronze RD CMS Standard Tier 2 - Generic QL
Connect Gold CMS Standard Tier 2 - Generic QL
Connect Silver RD CMS Standard Tier 2 - Generic QL
Connect Silver CMS Standard Tier 2 - Generic QL
Connect Bronze 7000 HSA Indiv Med Deductible Tier 2 - Generic QL
Connect Silver RD 3500 Indiv Med Deductible Tier 2 - Generic QL
Connect Bronze RD 5000 Indiv Med Deductible Tier 2 - Generic QL
Connect Silver 3500 Indiv Med Deductible Tier 2 - Generic QL
Connect Bronze RD 6000 Indiv Med Deductible Tier 2 - Generic QL
Connect Bronze 5500 Indiv Med Deductible Tier 2 - Generic QL
Connect myDiabetesCare Bronze Tier 2 - Generic QL
Connect Gold 1500 Indiv Med Deductible Tier 2 - Generic QL
Connect Silver RD 2200 Indiv Med Deductible Tier 2 - Generic QL
Connect myDiabetesCare Silver Tier 2 - Generic QL
Connect Bronze 6500 Indiv Med Deductible Tier 2 - Generic QL
Connect Silver 3000 Indiv Med Deductible Tier 2 - Generic QL
Connect Silver RD 5000 Indiv Med Deductible Tier 2 - Generic QL
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Alignment Health Platinum Select (HMO) Tier 3 - Preferred Brand None
Alignment Health Platinum (HMO) Tier 3 - Preferred Brand None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 3 - Preferred Brand None
Alignment Health smartHMO (HMO) Tier 3 - Preferred Brand None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 3 - Preferred Brand None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 3 - Preferred Brand None
Alignment Health AVA (PPO) Tier 3 - Preferred Brand None
DEVOTED CORE 001 NC (HMO) Tier 4 - Non-Preferred None
DEVOTED GIVEBACK 002 NC (HMO) Tier 4 - Non-Preferred None
DEVOTED GIVEBACK 012 NC (HMO) Tier 4 - Non-Preferred None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 4 - Non-Preferred None
HealthSpring TotalCare (HMO D-SNP) Tier 4 - Non-Preferred None
HealthSpring True Choice (PPO) Tier 4 - Non-Preferred None
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred None
Aetna Medicare Chronic Care (HMO C-SNP) Tier 4 - Non-Preferred None
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred None
Aetna Medicare Signature Giveback (PPO) Tier 4 - Non-Preferred None
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred None
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred None
Aetna Medicare Signature Extra (PPO) Tier 4 - Non-Preferred None
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred None
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred None
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred None
Aetna Medicare Enhanced (HMO) Tier 4 - Non-Preferred None
Blue Medicare PPO Enhanced (PPO) Tier 4 - Non-Preferred None
Blue Medicare Essential Plus (HMO-POS) Tier 4 - Non-Preferred None
Blue Medicare Enhanced (HMO-POS) Tier 4 - Non-Preferred None
Blue Medicare Choice (HMO) Tier 4 - Non-Preferred None
Blue Medicare Essential (HMO) Tier 4 - Non-Preferred None
Experience Health Medicare Advantage (HMO) Tier 4 - Non-Preferred None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 4 - Non-Preferred None
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 4 - Non-Preferred None
Aetna Medicare Signature Care (HMO) Tier 4 - Non-Preferred None
Aetna Medicare Prime (HMO) Tier 4 - Non-Preferred None
Aetna Medicare Value Plus (HMO) Tier 4 - Non-Preferred None
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred None
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred None
Aetna Medicare Dual (HMO D-SNP) Tier 4 - Non-Preferred None
HealthSpring Preferred (HMO) Tier 4 - Non-Preferred None
HealthSpring Preferred Select (HMO) Tier 4 - Non-Preferred None
HealthSpring Preferred Savings (HMO) Tier 4 - Non-Preferred None
HealthSpring Preferred Plus (HMO) Tier 4 - Non-Preferred None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 4 - Non-Preferred None
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 4 - Non-Preferred None
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