Premarin

Generic: estrogens, conjugated

0.625 MG — Tablet

Also known as: PREMARIN TABS .3MG, .45MG, .625MG, .9MG, 1.25MG estrogens, conjugated (USP) Premarin 0.3 Mg Tablet Premarin 0.45 Mg Tablet Premarin 0.625 Mg Tablet Premarin 0.9 Mg Tablet Premarin 1.25 Mg Tablet PREMARIN TABS .3MG, .45MG, .625MG, .9MG, Premarin Oral Tablet Estrogens, Conjugated (USP)

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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)

58 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 16 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Elite Bronze with Atrium Health + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Complete Gold via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Elite Bronze via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Silver via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Gold via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Complete Gold + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Gold with Atrium Health via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Silver with Atrium Health via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze with Atrium Health via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Gold with Atrium Health + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Silver with Atrium Health + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Gold + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Silver + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	✓	QL
Complete Gold	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Gold + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Silver + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Gold with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Silver with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Expanded Bronze with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Gold	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Silver	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Expanded Bronze	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 3 - Preferred Brand	—	—	✓	QL

AmeriHealth Caritas NC

10 plans

Source: CMS QHP JSON · Checked: 16 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Bronze Essential + No Referrals	Tier 4 - Non-Preferred	—	✓	—	ST
AmeriHealth Caritas Next Gold Signature + No Referrals	Tier 4 - Non-Preferred	—	✓	—	ST
AmeriHealth Caritas Next Silver Essential + No Referrals	Tier 4 - Non-Preferred	—	✓	—	ST
AmeriHealth Caritas Next Bronze Signature + No Referrals	Tier 4 - Non-Preferred	—	✓	—	ST
AmeriHealth Caritas Next Silver Signature + No Referrals	Tier 4 - Non-Preferred	—	✓	—	ST
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Tier 4 - Non-Preferred	—	✓	—	ST
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 4 - Non-Preferred	—	✓	—	ST
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Tier 4 - Non-Preferred	—	✓	—	ST
AmeriHealth Caritas Next Bronze Premier + No Referrals	Tier 4 - Non-Preferred	—	✓	—	ST
AmeriHealth Caritas Next Gold Premier + No Referrals	Tier 4 - Non-Preferred	—	✓	—	ST

Blue Cross Blue Shield Federal

5 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 16 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026 via estrogens, conjugated	Tier 1 - Generic	—	—	—	None
BCBS Federal Focus 2026 via estrogens, conjugated	Tier 1 - Generic	—	—	—	None
BCBS Federal Standard Option 2026 via estrogens, conjugated	Tier 1 - Generic	—	—	—	None
BCBS Federal Basic Option 2026	Tier 3 - Non-Preferred Brand	—	—	—	None
BCBS Federal Standard Option 2026	Tier 3 - Non-Preferred Brand	—	—	—	None

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 16 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Care 2026	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Value 2026	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Advantage 2026	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Local 2026	Tier 3 - High Cost Brand	—	—	—	None

Cigna

20 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 16 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect myDiabetesCare Bronze	Tier 4 - Non-Preferred	—	—	—	None
Connect myDiabetesCare Silver	Tier 4 - Non-Preferred	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Gold 1500 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Silver 3500 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Silver 4400 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Silver 3000 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible	Tier 4 - Non-Preferred	—	—	—	None
Connect Silver CMS Standard	Tier 4 - Non-Preferred	—	—	—	None
Connect Silver RD CMS Standard	Tier 4 - Non-Preferred	—	—	—	None
Connect Gold CMS Standard	Tier 4 - Non-Preferred	—	—	—	None
Connect Bronze RD CMS Standard	Tier 4 - Non-Preferred	—	—	—	None
Connect Gold RD CMS Standard	Tier 4 - Non-Preferred	—	—	—	None
Connect Bronze CMS Standard	Tier 4 - Non-Preferred	—	—	—	None

Medicare Part D

171 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 16 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Provider Partners North Carolina Advantage Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Community Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
Liberty Medicare Dual Plan (HMO D-SNP) via estrogens, conjugated (USP)	Tier 1 - Preferred Generic	—	—	—	None
NHC Advantage (HMO I-SNP) via estrogens, conjugated (USP)	Tier 1 - Preferred Generic	—	—	—	None
PruittHealth Premier (HMO I-SNP) via estrogens, conjugated (USP)	Tier 1 - Preferred Generic	—	—	—	None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) via estrogens, conjugated (USP)	Tier 1 - Preferred Generic	—	—	—	None
Longevity Health Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
Longevity Health Plan (HMO I-SNP) via estrogens, conjugated (USP)	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Essential Plan (HMO I-SNP) via estrogens, conjugated (USP)	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Community Plan (HMO I-SNP) via estrogens, conjugated (USP)	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Advantage Plan (HMO I-SNP) via estrogens, conjugated (USP)	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Essential Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
Liberty Medicare Advantage (HMO C-SNP) via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	—	None
Senior Care (HMO I-SNP) via estrogens, conjugated (USP)	Tier 2 - Generic	—	—	—	None
Healthy Blue + Medicare (HMO-POS D-SNP) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health Platinum (HMO) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health NC Duals (HMO-POS D-SNP) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health smartHMO (HMO) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health Platinum Select (HMO) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health Heart & Diabetes Care (HMO C-SNP) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
HealthSpring Preferred Savings (HMO)	Tier 3 - Preferred Brand	—	—	—	None
HealthSpring Preferred Plus (HMO)	Tier 3 - Preferred Brand	—	—	—	None
HealthSpring True Choice (PPO)	Tier 3 - Preferred Brand	—	—	—	None
HealthSpring TotalCare (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
HealthSpring TotalCare Plus (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
HealthSpring Preferred (HMO)	Tier 3 - Preferred Brand	—	—	—	None
HealthSpring Preferred Select (HMO)	Tier 3 - Preferred Brand	—	—	—	None
Troy Medicare (HMO)	Tier 3 - Preferred Brand	—	—	—	None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health AVA (PPO) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare PPO Enhanced (PPO)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Essential Plus (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Enhanced (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Choice (HMO)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Essential (HMO)	Tier 3 - Preferred Brand	—	—	—	None
Experience Health Medicare Advantage (HMO)	Tier 3 - Preferred Brand	—	—	—	None
Healthy Blue + Medicare (HMO-POS D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare PPO Enhanced (PPO) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Essential Plus (HMO-POS) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Enhanced (HMO-POS) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Choice (HMO) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Essential (HMO) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
Experience Health Medicare Advantage (HMO) via estrogens, conjugated (USP)	Tier 3 - Preferred Brand	—	—	—	None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
UHC Complete Care NC-27 (HMO-POS C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Liberty (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Freedom (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Guardian (HMO-POS I-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Erickson Advantage Signature (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (HMO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Dual (HMO D-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (HMO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Value Plus (HMO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Prime (HMO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature Care (HMO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Full Dual Care (HMO D-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Enhanced (HMO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Enhanced (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Enhanced (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature Extra (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature Giveback (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Chronic Care (HMO C-SNP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Chronic Care Value (HMO C-SNP)	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Chronic Care (HMO C-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Chronic Care Value (HMO C-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
HealthTeam Advantage Plan I (PPO)	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Plan II (PPO)	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Vitality Plan (PPO)	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Plan I (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Plan II (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Vitality Plan (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5216-211 (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Full Access H5525-034 (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice Giveback H5525-035 (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-049 (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-050 (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-070 (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H5525-072 (PPO D-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-083 (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-025 (HMO-POS) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-026 (HMO-POS) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H6622-027 (HMO-POS D-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-057 (HMO-POS) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-060 (HMO-POS) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-061 (HMO-POS) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Choice H8145-004 (PFFS) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0019 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0017 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0016 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0004 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage from UHC NC-0001 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-S2 (PPO D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Dual Complete NC-S001 (PPO D-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature Giveback (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature Extra (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Enhanced (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Enhanced (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Enhanced (HMO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Full Dual Care (HMO D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature Care (HMO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Prime (HMO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Value Plus (HMO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (HMO)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Dual (HMO D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (HMO)	Tier 4 - Non-Preferred	—	—	—	None
Erickson Advantage Champion (HMO-POS C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Complete Care NC-28 (HMO-POS C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
UHC Complete Care NC-25 (HMO-POS C-SNP)	Tier 4 - Non-Preferred	—	—	✓ 30 per 30 days	QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H1036-335 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice Giveback H5216-017 (PPO)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5216-211 (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Humana Full Access H5525-034 (PPO)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice Giveback H5525-035 (PPO)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-049 (PPO)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-050 (PPO)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-070 (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H5525-072 (PPO D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-083 (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-025 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-026 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H6622-027 (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-057 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-060 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-061 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Choice H8145-004 (PFFS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H1036-137 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H1036-233 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H1036-307 (HMO D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus Giveback H1036-318 (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H1036-137 (HMO-POS) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H1036-233 (HMO-POS) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H1036-307 (HMO D-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus Giveback H1036-318 (HMO-POS) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H1036-335 (HMO-POS) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice Giveback H5216-017 (PPO) via estrogens, conjugated (USP)	Tier 4 - Non-Preferred	—	—	—	None

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 16 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Preferred	—	—	—	None

NC State Health Plan

6 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 16 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via estrogens, conjugated	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via estrogens, conjugated	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via estrogens, conjugated	Tier 1 - Preferred Generic	—	—	—	None
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

Oscar Health

28 plans

Source: CMS QHP JSON · Checked: 16 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Silver Classic	Tier 3 - Preferred Brand	—	—	✓	QL
Secure	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic 4700	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple PCP Saver	Tier 3 - Preferred Brand	—	—	✓	QL
Gold Elite Saver Plus	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Diabetes	Tier 3 - Preferred Brand	—	—	✓	QL
Secure \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic 4700 \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Elite + PCP Saver Plus \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Diabetes \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple PCP Saver \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Gold Elite Saver Plus \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Diabetes \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Chronic Care CKM \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
AIAN Cost Share	Tier 3 - Preferred Brand	—	—	✓	QL
AIAN Cost Share \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Elite + PCP Saver Plus	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic Standard	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic Standard	Tier 3 - Preferred Brand	—	—	✓	QL
Gold Classic Standard	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic Standard \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic Standard \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL
Gold Classic Standard \| with Atrium Health	Tier 3 - Preferred Brand	—	—	✓	QL

UnitedHealthcare

13 plans

Source: PDF · Formulary date: Jun 23, 2026 · Checked: 16 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Standard (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 Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, 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 Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, 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 Standard+ Dental + Vision (No Referrals)	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Standard (No Referrals)	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Standard (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