Oriahnn 28 Day Kit

Generic: elagolix

300 MG — Capsule

Gonadotropin Releasing Hormone Receptor Antagonist

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Elite Bronze with Atrium Health + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Complete Gold with Atrium Health + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Expanded Bronze + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Silver + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Gold + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Silver with Atrium Health + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Gold with Atrium Health + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Complete Gold via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Everyday Bronze via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Elite Bronze via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Clear Silver with $0 Insulin Options via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Expanded Bronze via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Silver via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Gold via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Everyday Bronze with Atrium Health via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Elite Bronze with Atrium Health via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Everyday Bronze with Atrium Health + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Focused Silver with Atrium Health via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Complete Gold with Atrium Health via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Expanded Bronze with Atrium Health via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Silver with Atrium Health via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Standard Gold with Atrium Health via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Complete Gold + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Everyday Bronze + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Elite Bronze + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA
Focused Silver with Atrium Health + Vision + Adult Dental via Orilissa	Tier 3 - Preferred Brand	✓	—	—	PA

Blue Cross Blue Shield Federal

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026 via Orilissa	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Standard Option 2026 via Orilissa	Tier 3 - Non-Preferred Brand	✓	—	—	PA

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Local 2026 via Orilissa	Tier 3 - High Cost Brand	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Value 2026 via Orilissa	Tier 3 - High Cost Brand	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Advantage 2026 via Orilissa	Tier 3 - High Cost Brand	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Care 2026 via Orilissa	Tier 3 - High Cost Brand	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026 via Orilissa	Tier 3 - High Cost Brand	✓	—	✓ Restricted Access	PA \| QL

Medicare Part D

6 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via Orilissa	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare (HMO) via Orilissa	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare (HMO)	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas VIP Care (HMO D-SNP) via Orilissa	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 5 - Specialty	✓	—	—	PA

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Orilissa	Preferred	—	—	—	None

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Orilissa	Tier 2 - Non-Preferred Generic	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026 via Orilissa	Tier 2 - Non-Preferred Generic	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026 via Orilissa	Tier 2 - Non-Preferred Generic	✓	—	—	PA

UnitedHealthcare

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026 via Orilissa	Unknown	✓	—	✓	PA \| QL

Oriahnn 28 Day Kit

Coverage by Insurer

Ambetter (Centene)

Blue Cross Blue Shield Federal

Blue Cross Blue Shield of NC

Medicare Part D

NC Medicaid PDL

NC State Health Plan

UnitedHealthcare

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