Peg-Prep

Generic: bisacodyl

Kit

ANTIEMETICS

Also known as: PEG-PREP KIT Peg-Prep Kit
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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: 22 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Elite Bronze with Atrium Health
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Clear Silver with $0 Insulin Options
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Silver
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Gold
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Everyday Bronze with Atrium Health
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Elite Bronze with Atrium Health
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Focused Silver with Atrium Health
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Complete Gold with Atrium Health
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze with Atrium Health
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Silver with Atrium Health
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Gold with Atrium Health
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Complete Gold + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Elite Bronze + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Silver + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Gold + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Silver with Atrium Health + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Gold with Atrium Health + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Complete Gold + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Everyday Bronze + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Elite Bronze + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Silver + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Gold + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Silver with Atrium Health + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Gold with Atrium Health + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Complete Gold
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Everyday Bronze
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Elite Bronze
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Clear Silver with $0 Insulin Options
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Silver
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Gold
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Everyday Bronze with Atrium Health
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Elite Bronze with Atrium Health
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Focused Silver with Atrium Health
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Complete Gold with Atrium Health
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze with Atrium Health
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Silver with Atrium Health
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Everyday Bronze + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Elite Bronze + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Elite Bronze
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Complete Gold + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Gold with Atrium Health
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Everyday Bronze with Atrium Health
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Gold
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Silver
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Clear Silver with $0 Insulin Options
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Elite Bronze
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Everyday Bronze
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Silver with Atrium Health
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze with Atrium Health
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Complete Gold with Atrium Health
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Focused Silver with Atrium Health
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Complete Gold
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Everyday Bronze + Vision + Adult Dental
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Everyday Bronze
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Complete Gold
via Dulcolax 		Tier 1 - Preferred Generic — — — None
Standard Gold with Atrium Health + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Silver with Atrium Health + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Gold + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Silver + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Standard Expanded Bronze + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via bisacodyl 		Tier 1 - Preferred Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Standard Gold with Atrium Health
via The Magic Bullet 		Tier 1 - Preferred Generic — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 22 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Care 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Local 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 4 - Higher Cost Brand — — — None
BCBSNC Blue Advantage 2026 Tier 4 - Higher Cost Brand — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 22 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze CMS Standard Tier 2 - Generic — — — None
Connect myDiabetesCare Silver Tier 2 - Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Gold 1500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect myDiabetesCare Bronze Tier 2 - Generic — — — None
Connect Bronze 5500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze RD 6000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 3500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze 7000 HSA Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 4400 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 3000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze 6500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver CMS Standard Tier 2 - Generic — — — None
Connect Silver RD CMS Standard Tier 2 - Generic — — — None
Connect Gold CMS Standard Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard Tier 2 - Generic — — — None
Connect Gold RD CMS Standard Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 22 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 0 - $0 Copay (ACA Preventive) — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 0 - $0 Copay (ACA Preventive) — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 0 - $0 Copay (ACA Preventive) — — — None
Source: CMS QHP JSON  ·  Checked: 22 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Gold Classic Standard | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Gold Classic Standard
via bisacodyl 		Tier 2 - Generic — — — None
Silver Classic Standard
via bisacodyl 		Tier 2 - Generic — — — None
Bronze Classic Standard
via bisacodyl 		Tier 2 - Generic — — — None
Bronze Classic 4700
via bisacodyl 		Tier 2 - Generic — — — None
Silver Classic
via bisacodyl 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus
via bisacodyl 		Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Gold Elite Saver Plus | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Silver Classic | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Secure | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Silver Simple Diabetes
via bisacodyl 		Tier 2 - Generic — — — None
Gold Elite Saver Plus
via bisacodyl 		Tier 2 - Generic — — — None
Silver Simple PCP Saver
via bisacodyl 		Tier 2 - Generic — — — None
Secure
via bisacodyl 		Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
AIAN Cost Share
via bisacodyl 		Tier 2 - Generic — — — None
AIAN Cost Share | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health
via bisacodyl 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 22 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Standard (No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Standard (No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Standard (No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Standard+ Dental + Vision (No Referrals)
via bisacodyl 		Tier 0 - $0 Preventive — — ✓ QL
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