phenoxybenzamine hydrochloride

10 MG — Capsule

alpha-Adrenergic Blocker

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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: 17 hours, 29 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold Tier 4 - Non-Preferred ✓ — — PA
Complete Gold 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
Everyday Bronze Tier 4 - Non-Preferred ✓ — — PA
Elite Bronze 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
Standard Expanded Bronze with Atrium Health 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
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
Standard Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 4 - Non-Preferred ✓ — — PA
Source: CMS QHP JSON  ·  Checked: 17 hours, 29 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 5 - Specialty — — — None
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 5 - Specialty — — — None
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 5 - Specialty — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 5 - Specialty — — — None
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 5 - Specialty — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 5 - Specialty — — — None
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 5 - Specialty — — — None
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 5 - Specialty — — — None
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 5 - Specialty — — — None
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 5 - Specialty — — — None
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 17 hours, 29 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Blue Medicare Choice (HMO) Tier 5 - Specialty — — — None
HealthSpring True Choice (PPO) Tier 5 - Specialty — — — None
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 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
Source: CMS QHP JSON  ·  Checked: 17 hours, 29 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Gold Elite Saver Plus Tier 4 - Non-Preferred ✓ — — PA
Silver Simple Diabetes Tier 4 - Non-Preferred ✓ — — PA
Secure | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Bronze Classic 4700 | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Silver Classic | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Silver Simple Diabetes | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Silver Simple PCP Saver | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Gold Elite Saver Plus | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Silver Simple PCP Saver Tier 4 - Non-Preferred ✓ — — PA
Bronze Simple Chronic Care CKM | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Bronze Simple Diabetes | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Silver Simple Chronic Care CKM | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
AIAN Cost Share Tier 4 - Non-Preferred ✓ — — PA
AIAN Cost Share | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Bronze Classic 4700 Tier 4 - Non-Preferred ✓ — — PA
Secure Tier 4 - Non-Preferred ✓ — — PA
Silver Classic Tier 4 - Non-Preferred ✓ — — PA
Bronze Elite + PCP Saver Plus Tier 4 - Non-Preferred ✓ — — PA
Gold Classic Standard | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Silver Classic Standard | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Bronze Classic Standard | with Atrium Health Tier 4 - Non-Preferred ✓ — — PA
Gold Classic Standard Tier 4 - Non-Preferred ✓ — — PA
Silver Classic Standard Tier 4 - Non-Preferred ✓ — — PA
Bronze Classic Standard Tier 4 - Non-Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 17 hours, 29 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Gold Standard (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 4 - Non-Preferred — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Standard (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Standard (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
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