Orilissa
Generic: elagolix
150MG, 200MG — Tablet
Also known as:
ORILISSA TABS 150MG, 200MG
elagolix
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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)
29 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Silver + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Gold + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Complete Gold | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Everyday Bronze | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Elite Bronze | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Clear Silver with $0 Insulin Options | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Expanded Bronze | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Silver | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Gold | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Elite Bronze with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Focused Silver with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Complete Gold with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Expanded Bronze with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Silver with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Standard Gold with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Complete Gold + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Everyday Bronze + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Elite Bronze + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
2 plansBlue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Local 2026 | Tier 3 - High Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Value 2026 | Tier 3 - High Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Advantage 2026 | Tier 3 - High Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Care 2026 | Tier 3 - High Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 3 - High Cost Brand | ✓ | — | ✓ Restricted Access | PA | QL |
Medicare Part D
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Troy Medicare (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare (HMO)
via Oriahnn 28 Day Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Oriahnn 28 Day Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Oriahnn 28 Day Kit |
Tier 5 - Specialty | ✓ | — | — | PA |
NC Medicaid PDL
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 2 - Non-Preferred Generic | ✓ | — | — | PA |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 2 - Non-Preferred Generic | ✓ | — | — | PA |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 2 - Non-Preferred Generic | ✓ | — | — | PA |