Niva Thyroid

Generic: thyroid

120 Mg — Tablet

ANTIDIABETICS

Also known as: Niva Thyroid 15 Mg Tablet Niva Thyroid 30 Mg Tablet Niva Thyroid 60 Mg Tablet Niva Thyroid 90 Mg Tablet Niva Thyroid 120 Mg Tablet thyroid (USP)

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: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Gold + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Silver + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Gold with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Silver with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Complete Gold with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Everyday Bronze with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Gold
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Silver
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze
via Evexithroid
Tier 3 - Preferred Brand QL
Clear Silver with $0 Insulin Options
via Evexithroid
Tier 3 - Preferred Brand QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Elite Bronze + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Everyday Bronze + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Complete Gold + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Gold with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Silver with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Complete Gold
via Evexithroid
Tier 3 - Preferred Brand QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Evexithroid
Tier 3 - Preferred Brand QL
Everyday Bronze
via Evexithroid
Tier 3 - Preferred Brand QL
Elite Bronze
via Evexithroid
Tier 3 - Preferred Brand QL
Elite Bronze with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Focused Silver with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Complete Gold + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Everyday Bronze + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Elite Bronze + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Complete Gold
via Armour Thyroid
Tier 3 - Preferred Brand QL
Everyday Bronze
via Armour Thyroid
Tier 3 - Preferred Brand QL
Elite Bronze
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Silver + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Gold + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Everyday Bronze with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Gold
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Silver
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze
via Armour Thyroid
Tier 3 - Preferred Brand QL
Clear Silver with $0 Insulin Options
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Silver with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Silver with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Armour Thyroid
Tier 3 - Preferred Brand QL
Complete Gold with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Focused Silver with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Elite Bronze with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via Thyroid
Tier 2 - Preferred Brand None
BCBS Federal Focus 2026
via Armour Thyroid
Tier 2 - Preferred Brand None
BCBS Federal Standard Option 2026
via Armour Thyroid
Tier 3 - Non-Preferred Brand None
BCBS Federal Standard Option 2026
via Thyroid
Tier 3 - Non-Preferred Brand None
BCBS Federal Basic Option 2026
via Thyroid
Tier 3 - Non-Preferred Brand None
BCBS Federal Basic Option 2026
via Armour Thyroid
Tier 3 - Non-Preferred Brand None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via Np Thyroid 90
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Armour Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Armour Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Armour Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Armour Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Armour Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Evexithroid
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Evexithroid
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Evexithroid
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Evexithroid
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Evexithroid
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026 Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026 Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026 Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026 Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Np Thyroid 120
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Np Thyroid 120
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Np Thyroid 120
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Np Thyroid 120
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Np Thyroid 120
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Np Thyroid 15
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Np Thyroid 15
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Np Thyroid 15
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Np Thyroid 15
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Np Thyroid 15
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Np Thyroid 30
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Np Thyroid 30
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Np Thyroid 30
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Np Thyroid 30
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Np Thyroid 30
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Np Thyroid 60
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Np Thyroid 60
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Np Thyroid 60
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Np Thyroid 60
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Np Thyroid 60
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Np Thyroid 90
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Np Thyroid 90
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Np Thyroid 90
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Np Thyroid 90
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Renthyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Renthyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Renthyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Renthyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Renthyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Thyroid
Tier 3 - High Cost Brand None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 6500 Indiv Med Deductible Tier 2 - Generic None
Connect Silver CMS Standard Tier 2 - Generic None
Connect Silver RD CMS Standard Tier 2 - Generic None
Connect Gold CMS Standard Tier 2 - Generic None
Connect Bronze RD CMS Standard Tier 2 - Generic None
Connect Gold RD CMS Standard Tier 2 - Generic None
Connect Bronze CMS Standard Tier 2 - Generic None
Connect Silver 3500 Indiv Med Deductible Tier 2 - Generic None
Connect Bronze RD 5000 Indiv Med Deductible Tier 2 - Generic None
Connect Silver RD 3500 Indiv Med Deductible Tier 2 - Generic None
Connect Bronze 7000 HSA Indiv Med Deductible Tier 2 - Generic None
Connect Silver RD 2200 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Gold 1500 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect myDiabetesCare Bronze
via Thyroid
Tier 2 - Generic None
Connect Bronze 5500 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Bronze RD 6000 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Silver 3500 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Bronze RD 5000 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Silver RD 3500 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Bronze 7000 HSA Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Silver 4400 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Silver RD 5000 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Silver 3000 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Bronze 6500 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect myDiabetesCare Silver Tier 2 - Generic None
Connect Silver RD 2200 Indiv Med Deductible Tier 2 - Generic None
Connect Gold 1500 Indiv Med Deductible Tier 2 - Generic None
Connect myDiabetesCare Bronze Tier 2 - Generic None
Connect Bronze 5500 Indiv Med Deductible Tier 2 - Generic None
Connect Bronze RD 6000 Indiv Med Deductible Tier 2 - Generic None
Connect myDiabetesCare Silver
via Thyroid
Tier 2 - Generic None
Connect Silver 4400 Indiv Med Deductible Tier 2 - Generic None
Connect Silver RD 5000 Indiv Med Deductible Tier 2 - Generic None
Connect Silver 3000 Indiv Med Deductible Tier 2 - Generic None
Connect Silver CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Silver RD CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Gold CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Bronze RD CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Gold RD CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Bronze CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Silver 3500 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver 3000 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver RD 5000 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver 4400 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver RD CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Gold CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze RD CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Gold RD CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze 7000 HSA Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver RD 3500 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze RD 5000 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze 6500 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze RD 6000 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze 5500 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect myDiabetesCare Bronze
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Gold 1500 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver RD 2200 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect myDiabetesCare Silver
via Armour Thyroid
Tier 3 - Preferred Brand None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026
via Np Thyroid 120
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Np Thyroid 60
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via Np Thyroid 60
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Np Thyroid 60
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Np Thyroid 90
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via Np Thyroid 90
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Np Thyroid 90
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Np Thyroid 120
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Np Thyroid 15
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Np Thyroid 120
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Armour Thyroid
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via Np Thyroid 15
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Armour Thyroid
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via Armour Thyroid
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Np Thyroid 15
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Np Thyroid 30
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via Np Thyroid 30
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Np Thyroid 30
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Renthyroid
Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026
via Renthyroid
Not Covered None
NC State Health Plan - HDHP 2026
via Renthyroid
Not Covered None
NC State Health Plan - 80/20 Plus PPO 2026
via Thyroid
Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026
via Thyroid
Not Covered None
NC State Health Plan - HDHP 2026
via Thyroid
Not Covered None
NC State Health Plan - HDHP 2026
via Evexithroid
Not Covered None
NC State Health Plan - 80/20 Plus PPO 2026
via Evexithroid
Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026
via Evexithroid
Not Covered None
Source: CMS QHP JSON  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Gold Classic Standard
via Armour Thyroid
Tier 2 - Generic None
Bronze Classic Standard | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Classic Standard | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Gold Classic Standard | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Elite + PCP Saver Plus
via Armour Thyroid
Tier 2 - Generic None
Silver Classic
via Armour Thyroid
Tier 2 - Generic None
Secure
via Armour Thyroid
Tier 2 - Generic None
Bronze Classic 4700
via Armour Thyroid
Tier 2 - Generic None
Silver Simple PCP Saver
via Armour Thyroid
Tier 2 - Generic None
Gold Elite Saver Plus
via Armour Thyroid
Tier 2 - Generic None
Silver Simple Diabetes
via Armour Thyroid
Tier 2 - Generic None
Secure | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Classic 4700 | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Elite + PCP Saver Plus | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Classic | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Simple Diabetes | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Simple PCP Saver | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Gold Elite Saver Plus | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Simple Chronic Care CKM | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Simple Diabetes | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Simple Chronic Care CKM | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
AIAN Cost Share
via Armour Thyroid
Tier 2 - Generic None
AIAN Cost Share | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Classic Standard
via Armour Thyroid
Tier 2 - Generic None
Silver Classic Standard
via Armour Thyroid
Tier 2 - Generic None
AIAN Cost Share Tier 2 - Generic None
AIAN Cost Share | with Atrium Health Tier 2 - Generic None
Silver Classic | with Atrium Health Tier 2 - Generic None
Silver Simple Diabetes | with Atrium Health Tier 2 - Generic None
Silver Simple PCP Saver | with Atrium Health Tier 2 - Generic None
Gold Elite Saver Plus | with Atrium Health 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
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
Bronze Classic Standard Tier 2 - Generic None
Silver Classic Standard Tier 2 - Generic None
Gold Classic Standard Tier 2 - Generic None
Bronze Classic Standard | with Atrium Health Tier 2 - Generic None
Silver Classic Standard | with Atrium Health Tier 2 - Generic None
Gold Classic Standard | with Atrium Health Tier 2 - Generic None
Bronze Elite + PCP Saver Plus Tier 2 - Generic None
Silver Classic Tier 2 - Generic None
Secure Tier 2 - Generic None
Bronze Classic 4700 Tier 2 - Generic None
Silver Simple PCP Saver Tier 2 - Generic None
Gold Elite Saver Plus Tier 2 - Generic None
Silver Simple Diabetes Tier 2 - Generic None
Secure | with Atrium Health Tier 2 - Generic None
Bronze Classic 4700 | with Atrium Health Tier 2 - Generic None
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 2 - Generic None
Bronze Classic Standard
via thyroid (USP)
Tier 2 - Generic None
Silver Classic Standard
via thyroid (USP)
Tier 2 - Generic None
Gold Classic Standard
via thyroid (USP)
Tier 2 - Generic None
Bronze Classic Standard | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Classic Standard | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Gold Classic Standard | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Bronze Elite + PCP Saver Plus
via thyroid (USP)
Tier 2 - Generic None
Silver Classic
via thyroid (USP)
Tier 2 - Generic None
Secure
via thyroid (USP)
Tier 2 - Generic None
Bronze Classic 4700
via thyroid (USP)
Tier 2 - Generic None
Silver Simple PCP Saver
via thyroid (USP)
Tier 2 - Generic None
Gold Elite Saver Plus
via thyroid (USP)
Tier 2 - Generic None
Silver Simple Diabetes
via thyroid (USP)
Tier 2 - Generic None
Secure | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Bronze Classic 4700 | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Bronze Elite + PCP Saver Plus | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Classic | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Simple Diabetes | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Simple PCP Saver | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Gold Elite Saver Plus | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Bronze Simple Chronic Care CKM | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Bronze Simple Diabetes | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Simple Chronic Care CKM | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
AIAN Cost Share
via thyroid (USP)
Tier 2 - Generic None
AIAN Cost Share | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Gold Standard (No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Bronze Standard+ Dental + Vision (No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Silver Standard (No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Bronze Standard (No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Bronze Standard (No Referrals) Tier 4 - Non-Preferred None
UHC Silver Standard (No Referrals) Tier 4 - Non-Preferred None
UHC Gold Standard (No Referrals) Tier 4 - Non-Preferred None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred None
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 4 - Non-Preferred None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 4 - Non-Preferred None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 4 - Non-Preferred None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Silver Standard (No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Standard (No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Gold Standard (No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Standard+ Dental + Vision (No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
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