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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 |
|---|---|---|---|---|---|
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Clear Silver with $0 Insulin Options | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Expanded Bronze | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Silver | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Gold | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Elite Bronze with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Focused Silver with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Complete Gold with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Expanded Bronze with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Silver with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Gold with Atrium Health | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Complete Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Everyday Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Elite Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Silver + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Complete Gold | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Everyday Bronze | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Elite Bronze | Tier 4 - Non-Preferred | ✓ | — | — | PA |
Medicare Part D
24 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| HealthSpring TotalCare (HMO D-SNP) | Tier 5 - Specialty | — | — | — | None |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 5 - Specialty | — | — | — | None |
| HealthSpring Preferred (HMO) | Tier 5 - Specialty | — | — | — | None |
| HealthSpring Preferred Select (HMO) | Tier 5 - Specialty | — | — | — | None |
| HealthSpring Preferred Savings (HMO) | Tier 5 - Specialty | — | — | — | None |
| HealthSpring Preferred Plus (HMO) | Tier 5 - Specialty | — | — | — | None |
| Blue Medicare PPO Enhanced (PPO) | Tier 5 - Specialty | — | — | — | None |
| Blue Medicare Essential Plus (HMO-POS) | Tier 5 - Specialty | — | — | — | None |
| Blue Medicare Enhanced (HMO-POS) | Tier 5 - Specialty | — | — | — | None |
| Blue Medicare Choice (HMO) | Tier 5 - Specialty | — | — | — | None |
| Blue Medicare Essential (HMO) | Tier 5 - Specialty | — | — | — | None |
| Experience Health Medicare Advantage (HMO) | Tier 5 - Specialty | — | — | — | None |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 5 - Specialty | — | — | — | None |
| Alignment Health Platinum (HMO) | Tier 5 - Specialty | — | — | — | None |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 5 - Specialty | — | — | — | None |
| Alignment Health smartHMO (HMO) | Tier 5 - Specialty | — | — | — | None |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 5 - Specialty | — | — | — | None |
| Alignment Health Platinum Select (HMO) | Tier 5 - Specialty | — | — | — | None |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 5 - Specialty | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 5 - Specialty | — | — | — | None |
| 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) | Tier 5 - Specialty | ✓ | — | — | PA |
| HealthSpring True Choice (PPO) | Tier 5 - Specialty | — | — | — | None |