Orenitram

Generic: treprostinil

0.125 MG — Extended Release Tablet

Also known as: ORENITRAM TAB MONTH 1 ORENITRAM TAB MONTH 2 ORENITRAM TAB MONTH 3 treprostinil ORENITRAM TBCR .125MG, .25MG, 1MG, 2.5MG, 5MG Orenitram Oral Tablet Extended Release Treprostinil

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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.

Ambetter (Centene)

87 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 17 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Standard Gold with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Standard Gold + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Complete Gold	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze	Tier 5 - Specialty	✓	—	—	PA
Standard Silver	Tier 5 - Specialty	✓	—	—	PA
Standard Gold	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Clear Silver with $0 Insulin Options	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze	Tier 5 - Specialty	✓	—	—	PA
Complete Gold via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Clear Silver with $0 Insulin Options via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Silver via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Gold via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Silver + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Complete Gold + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Silver + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Gold + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Complete Gold + Vision + Adult Dental via treprostinil	Tier 5 - Specialty	✓	—	—	PA

AmeriHealth Caritas NC

20 plans

Source: CMS QHP JSON · Checked: 17 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Premier + No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Premier + No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Signature + No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Essential + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Essential + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Essential + No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Signature + No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Essential + No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Signature + No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Premier + No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	—	PA

Blue Cross Blue Shield Federal

5 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 17 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026	Tier 2 - Preferred Brand	✓	—	—	PA
BCBS Federal Standard Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026 via Remodulin	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026 via Remodulin	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

Blue Cross Blue Shield of NC

20 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 17 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026 via Yutrepia	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026 via Tyvaso	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Local 2026 via Tyvaso	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Care 2026 via Tyvaso	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Value 2026 via Tyvaso	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Advantage 2026	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Local 2026	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Care 2026	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Value 2026	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Advantage 2026 via Orenitram Titration	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026 via Orenitram Titration	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Local 2026 via Orenitram Titration	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Care 2026 via Orenitram Titration	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Value 2026 via Orenitram Titration	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Advantage 2026 via Yutrepia	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Advantage 2026 via Tyvaso	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Local 2026 via Yutrepia	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Care 2026 via Yutrepia	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Value 2026 via Yutrepia	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL

Cigna

20 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 17 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Gold RD CMS Standard via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect myDiabetesCare Silver via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Silver RD 2200 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Gold 1500 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect myDiabetesCare Bronze via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Bronze 5500 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Bronze RD 6000 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Silver 3500 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Bronze RD 5000 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Silver RD 3500 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Bronze 7000 HSA Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Silver 4400 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Silver RD 5000 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Silver 3000 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Bronze 6500 Indiv Med Deductible via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Bronze CMS Standard via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Gold CMS Standard via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Silver RD CMS Standard via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Silver CMS Standard via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Connect Bronze RD CMS Standard via Tyvaso	Tier 5 - Specialty	✓	—	—	PA

Medicare Part D

85 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 17 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Provider Partners North Carolina Advantage Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 504 per 365 days	PA \| QL
Provider Partners North Carolina Community Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 504 per 365 days	PA \| QL
Provider Partners North Carolina Essential Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 504 per 365 days	PA \| QL
HealthTeam Advantage Vitality Plan (PPO)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
UHC Dual Complete NC-S001 (PPO D-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
UHC Dual Complete NC-S2 (PPO D-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0001 (PPO)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0004 (PPO)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0016 (PPO)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0017 (PPO)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0019 (PPO)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
Erickson Advantage Signature (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
Erickson Advantage Guardian (HMO-POS I-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
Erickson Advantage Freedom (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
Erickson Advantage Liberty (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
UHC Complete Care NC-25 (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
UHC Complete Care NC-27 (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
UHC Complete Care NC-28 (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
Erickson Advantage Champion (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
HealthSpring True Choice (PPO)	Tier 5 - Specialty	✓	—	—	PA
HealthSpring TotalCare (HMO D-SNP)	Tier 5 - Specialty	✓	—	—	PA
HealthSpring TotalCare Plus (HMO D-SNP)	Tier 5 - Specialty	✓	—	—	PA
HealthSpring Preferred (HMO)	Tier 5 - Specialty	✓	—	—	PA
HealthSpring Preferred Select (HMO)	Tier 5 - Specialty	✓	—	—	PA
HealthSpring Preferred Savings (HMO)	Tier 5 - Specialty	✓	—	—	PA
HealthSpring Preferred Plus (HMO)	Tier 5 - Specialty	✓	—	—	PA
DEVOTED DUAL FULL 013 NC (HMO D-SNP) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED DUAL 009 NC (HMO D-SNP) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED CORE 001 NC (HMO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED GIVEBACK 002 NC (HMO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED GIVEBACK 012 NC (HMO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED CHOICE 001 NC (PPO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED CHOICE 003 NC (PPO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED CHOICE 005 NC (PPO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED CHOICE 008 NC (PPO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO) via Yutrepia	Tier 5 - Specialty	✓	—	✓ 224 per 28 days	PA \| QL
Blue Medicare PPO Enhanced (PPO)	Tier 5 - Specialty	✓	—	—	PA
Blue Medicare Essential Plus (HMO-POS)	Tier 5 - Specialty	✓	—	—	PA
Blue Medicare Enhanced (HMO-POS)	Tier 5 - Specialty	✓	—	—	PA
Blue Medicare Choice (HMO)	Tier 5 - Specialty	✓	—	—	PA
Blue Medicare Essential (HMO)	Tier 5 - Specialty	✓	—	—	PA
Experience Health Medicare Advantage (HMO)	Tier 5 - Specialty	✓	—	—	PA
Healthy Blue + Medicare (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	—	PA
Alignment Health Platinum (HMO)	Tier 5 - Specialty	✓	—	—	PA
Alignment Health NC Duals (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	—	PA
Alignment Health smartHMO (HMO)	Tier 5 - Specialty	✓	—	—	PA
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	—	PA
Alignment Health Platinum Select (HMO)	Tier 5 - Specialty	✓	—	—	PA
Alignment Health Heart & Diabetes Care (HMO C-SNP)	Tier 5 - Specialty	✓	—	—	PA
Alignment Health AVA (PPO)	Tier 5 - Specialty	✓	—	—	PA
HealthTeam Advantage Plan I (PPO)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
HealthTeam Advantage Plan II (PPO)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 504 per 365 days	PA \| QL
Troy Medicare (HMO) via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare (HMO) via Yutrepia	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via Yutrepia	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas VIP Care (HMO D-SNP) via Tyvaso	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas VIP Care (HMO D-SNP) via Yutrepia	Tier 5 - Specialty	✓	—	—	PA

NC State Health Plan

15 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 17 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via treprostinil	Tier 4 - Specialty Generic	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026 via treprostinil	Tier 4 - Specialty Generic	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026 via treprostinil	Tier 4 - Specialty Generic	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026 via Yutrepia	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - HDHP 2026 via Yutrepia	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - HDHP 2026	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026 via Yutrepia	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026 via Tyvaso	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026 via Tyvaso	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL
NC State Health Plan - HDHP 2026 via Tyvaso	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026 via Remodulin	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Remodulin	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Remodulin	Not Covered	—	—	—	None

Oscar Health

84 plans

Source: CMS QHP JSON · Checked: 17 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Bronze Classic 4700 \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Diabetes \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Elite Saver Plus \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Diabetes \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Chronic Care CKM \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
AIAN Cost Share	Tier 5 - Specialty	✓	—	✓	PA \| QL
AIAN Cost Share \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Classic via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Secure via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Bronze Classic 4700 via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Simple PCP Saver via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Gold Elite Saver Plus via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Simple Diabetes via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Secure \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Bronze Classic 4700 \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Bronze Elite + PCP Saver Plus \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Classic \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Simple Diabetes \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Simple PCP Saver \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Gold Elite Saver Plus \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Bronze Simple Chronic Care CKM \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Bronze Simple Diabetes \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Simple Chronic Care CKM \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
AIAN Cost Share via treprostinil	Tier 5 - Specialty	✓	—	—	PA
AIAN Cost Share \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Bronze Classic Standard via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Classic Standard via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Gold Classic Standard via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Bronze Classic Standard \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Silver Classic Standard \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Gold Classic Standard \| with Atrium Health via treprostinil	Tier 5 - Specialty	✓	—	—	PA
Bronze Classic Standard via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic Standard via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Classic Standard via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic Standard \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic Standard \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Classic Standard \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Secure via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic 4700 via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple PCP Saver via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Elite Saver Plus via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Diabetes via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Secure \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic 4700 \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Diabetes \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple PCP Saver \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Elite Saver Plus \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Chronic Care CKM \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Diabetes \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Chronic Care CKM \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
AIAN Cost Share via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
AIAN Cost Share \| with Atrium Health via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple PCP Saver \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Classic Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic Standard \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic Standard \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Classic Standard \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic	Tier 5 - Specialty	✓	—	✓	PA \| QL
Secure	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic 4700	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple PCP Saver	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Elite Saver Plus	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Diabetes	Tier 5 - Specialty	✓	—	✓	PA \| QL
Secure \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL

UnitedHealthcare

26 plans

Source: PDF · Formulary date: Jun 23, 2026 · Checked: 17 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Standard (No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Standard+ Dental + Vision (No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Standard (No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Standard (No Referrals) via Tyvaso	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Standard+ Dental + Vision (No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Standard (No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Standard (No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Standard (No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL