Odactra

Generic: dust mite mixed ext sl

Sublingual Tablet

BIOLOGICALS MISC

Also known as: American house dust mite allergenic extract
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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: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 10 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Local 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Value 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Advantage 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Care 2026 Tier 4 - Higher Cost Brand — — — None
Source: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 10 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver 3000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Gold 1500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze RD 6000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze RD CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD 3500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver RD 2200 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze 7000 HSA Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze 5500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Gold CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect myDiabetesCare Silver Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Gold RD CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver 3600 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze CMS Standard Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect myDiabetesCare Bronze Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Silver 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Connect Bronze 6500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 10 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
HealthTeam Advantage Plan II (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Vitality Plan (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Plan I (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
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