olmesartan medoxomil/amlodipine besylate/hydrochlorothiazide
20 mg-5 mg-12.5 mg, 40 mg-10 mg-12.5 mg, 40 mg-10 mg-25 mg, 40 mg-5 mg-12.5 mg, 40 mg-5 mg-25 mg — Tablet
RENIN-ANGIOTENSIN ANTIHYPERTENSIVES
Also known as:
OLMESARTAN-AMLODIPINE-HCTZ
TRIBENZOR
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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.
Blue Cross Blue Shield Federal
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Tribenzor |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Tribenzor |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Local 2026
via Tribenzor |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Tribenzor |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Value 2026
via Tribenzor |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Care 2026
via Tribenzor |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Tribenzor |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
Cigna
1 planNC Medicaid PDL
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC Medicaid Preferred Drug List 2026
via Olmesartan-Amlodipine-Hctz |
Preferred | — | — | — | None |
|
NC Medicaid Preferred Drug List 2026
via Tribenzor |
Non-Preferred | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - HDHP 2026
via Tribenzor |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Tribenzor |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Tribenzor |
Tier 3 - Non-Preferred Brand | — | — | — | None |