Osphena

Generic: ospemifene

60 MG — Tablet

Selective Estrogen Receptor Modifying Agents

Also known as: OSPHENA TABS 60MG ospemifene
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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: 4 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Complete Gold + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Gold with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Standard Silver with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Standard Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Gold + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Silver + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Complete Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Focused Silver with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Standard Gold Tier 4 - Non-Preferred ✓ — — PA
Standard Silver Tier 4 - Non-Preferred ✓ — — PA
Standard Expanded Bronze Tier 4 - Non-Preferred ✓ — — PA
Clear Silver with $0 Insulin Options Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze Tier 4 - Non-Preferred ✓ — — PA
Everyday Bronze Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 4 - Non-Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 4 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Standard Option 2026 Tier 3 - Non-Preferred Brand — — — None
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 4 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
Erickson Advantage Champion (HMO-POS C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
Erickson Advantage Liberty (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
Erickson Advantage Freedom (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
Erickson Advantage Signature (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Plan II (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Vitality Plan (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Plan I (PPO) Tier 3 - Preferred Brand ✓ — ✓ 30 per 30 days PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 4 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 4 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered — — — None
NC State Health Plan - HDHP 2026 Not Covered — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 4 hours, 20 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026 Tier 4 - Higher Cost ✓ — ✓ PA | QL
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