Osenvelt

Generic: denosumab-bmwo

120MG/1.7ML — Solution

RANK Ligand Inhibitor

Also known as: denosumab-bmwo OSENVELT SOLN 120MG/1.7ML
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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: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 10 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Signature Gold with Atrium Health + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Streamlined Silver with Atrium Health
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Gold + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Streamlined Silver
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Expanded Bronze
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Silver
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Gold
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Expanded Bronze with Atrium Health
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Silver with Atrium Health
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Gold with Atrium Health
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Expanded Bronze + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Silver + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced CHF Heart Care Silver $0 Rx Options
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Silver with Atrium Health + Vision + Adult Dental
via Stoboclo 		Tier 5 - Specialty ✓ — ✓ PA | QL
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 10 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Stoboclo 		Tier 1 - Preferred Generic — — ✓ 2 per 365 days QL
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Stoboclo 		Tier 1 - Preferred Generic — — ✓ 2 per 365 days QL
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Stoboclo 		Tier 1 - Preferred Generic — — ✓ 2 per 365 days QL
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Stoboclo 		Tier 3 - Preferred Brand — — — None
Troy Medicare (HMO)
via Stoboclo 		Tier 3 - Preferred Brand — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Stoboclo 		Tier 3 - Preferred Brand — — ✓ 1 per 180 days QL
Alignment Health NC Duals (HMO-POS D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Alignment Health smartHMO (HMO)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Alignment Health Platinum Select (HMO)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Erickson Advantage Signature (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Erickson Advantage Guardian (HMO-POS I-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Erickson Advantage Champion (HMO-POS C-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Erickson Advantage Freedom (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Erickson Advantage Liberty (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Alignment Health AVA (PPO)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Healthy Blue + Medicare (HMO-POS D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
HealthTeam Advantage Plan I (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 2 per 365 days QL
HealthTeam Advantage Plan II (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 2 per 365 days QL
HealthTeam Advantage Vitality Plan (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 2 per 365 days QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
UHC Dual Complete NC-S001 (PPO D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
UHC Dual Complete NC-S2 (PPO D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Wellcare Simple Open (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Wellcare Dual Liberty Open (PPO D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Wellcare Assist Open (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Wellcare Giveback Open (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 2 per 365 days QL
Blue Medicare PPO Enhanced (PPO)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Blue Medicare Essential Plus (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Blue Medicare Enhanced (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Blue Medicare Choice (HMO)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Blue Medicare Essential (HMO)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Experience Health Medicare Advantage (HMO)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
Wellcare Simple (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Wellcare Dual Access (HMO-POS D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Wellcare Dual Reserve (HMO-POS D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Wellcare Dual Liberty (HMO-POS D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Stoboclo 		Tier 4 - Non-Preferred — — ✓ 1 per 180 days QL
Alignment Health Platinum (HMO)
via Stoboclo 		Tier 4 - Non-Preferred ✓ — — PA
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 5 - Specialty — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 5 - Specialty — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 5 - Specialty — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 5 - Specialty — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 5 - Specialty — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 5 - Specialty — — — None
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
Erickson Advantage Signature (HMO-POS) Tier 5 - Specialty — — — None
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 5 - Specialty — — — None
Erickson Advantage Champion (HMO-POS C-SNP) Tier 5 - Specialty — — — None
Erickson Advantage Freedom (HMO-POS) Tier 5 - Specialty — — — None
Erickson Advantage Liberty (HMO-POS) Tier 5 - Specialty — — — None
Alignment Health AVA (PPO) Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 5 - Specialty — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
HealthTeam Advantage Plan I (PPO) Tier 5 - Specialty ✓ — — PA
HealthTeam Advantage Plan II (PPO) Tier 5 - Specialty ✓ — — PA
HealthTeam Advantage Vitality Plan (PPO) Tier 5 - Specialty ✓ — — PA
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 5 - Specialty — — — None
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 5 - Specialty — — — None
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 5 - Specialty — — — None
Wellcare Simple Open (PPO) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Liberty Open (PPO D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Assist Open (PPO) Tier 5 - Specialty ✓ — — PA
Wellcare Giveback Open (PPO) Tier 5 - Specialty ✓ — — PA
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 5 - Specialty — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
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
Wellcare Simple (HMO-POS) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Access (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Troy Medicare (HMO) Tier 5 - Specialty — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 5 - Specialty — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 5 - Specialty — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 10 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Stoboclo 		Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 10 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 5 - Preferred Brand Specialty ✓ — ✓ PA | QL
NC State Health Plan - 80/20 Plus PPO 2026 Tier 5 - Preferred Brand Specialty ✓ — ✓ PA | QL
NC State Health Plan - 70/30 Standard PPO 2026 Tier 5 - Preferred Brand Specialty ✓ — ✓ PA | QL
Source: CMS QHP JSON  ·  Checked: 10 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Bronze Simple Chronic Care CKM | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Secure | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Bronze Classic 4700 | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Bronze Elite + PCP Saver Plus | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Classic | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Simple Diabetes | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Simple PCP Saver | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Bronze Simple Diabetes | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Simple Chronic Care CKM | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Gold Classic Standard
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
AIAN Cost Share
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
AIAN Cost Share | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Bronze Classic Standard
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Simple Diabetes
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Simple PCP Saver
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Bronze Classic 4700
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Secure
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Classic Standard
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Classic
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Bronze Elite + PCP Saver Plus
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Bronze Classic Standard | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Silver Classic Standard | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
Gold Classic Standard | with Atrium Health
via Stoboclo 		Tier 5 - Specialty — — ✓ QL
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