Prevnar 20
Generic: Streptococcus pneumoniae serotype
0.0022 MG — Prefilled Syringe
Also known as:
Streptococcus pneumoniae serotype
Prevnar 20 Syringe
PREVNAR 20 INJ
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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)
116 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Standard Silver + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Elite Bronze + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Expanded Bronze | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Silver | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Gold | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Elite Bronze with Atrium Health | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Focused Silver with Atrium Health | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Complete Gold with Atrium Health | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health | Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Everyday Bronze + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Elite Bronze + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Expanded Bronze + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Complete Gold | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Everyday Bronze | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Elite Bronze | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Silver with Atrium Health | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Gold with Atrium Health | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Complete Gold + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Elite Bronze + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Silver + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Gold + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Complete Gold
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Everyday Bronze
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Elite Bronze
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Clear Silver with $0 Insulin Options
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Expanded Bronze
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Silver
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Gold
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Focused Silver with Atrium Health
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Complete Gold with Atrium Health
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Expanded Bronze with Atrium Health
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Silver with Atrium Health
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Gold with Atrium Health
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Complete Gold + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Gold + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Vaxneuvance |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Elite Bronze
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze with Atrium Health
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Elite Bronze with Atrium Health
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Focused Silver with Atrium Health
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold with Atrium Health
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver with Atrium Health
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold with Atrium Health
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via Capvaxive |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Elite Bronze
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze with Atrium Health
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Elite Bronze with Atrium Health
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Focused Silver with Atrium Health
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold with Atrium Health
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver with Atrium Health
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold with Atrium Health
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via Prevnar 13 |
Tier 0 - $0 Preventive | — | — | — | None |
Blue Cross Blue Shield of NC
15 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Capvaxive |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Local 2026
via Capvaxive |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Care 2026
via Capvaxive |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Value 2026
via Capvaxive |
Tier A - ACA $0 Copay | — | — | — | None |
| BCBSNC Blue Advantage 2026 | Tier A - ACA $0 Copay | — | — | — | None |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier A - ACA $0 Copay | — | — | — | None |
| BCBSNC Blue Local 2026 | Tier A - ACA $0 Copay | — | — | — | None |
| BCBSNC Blue Care 2026 | Tier A - ACA $0 Copay | — | — | — | None |
| BCBSNC Blue Value 2026 | Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Vaxneuvance |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Vaxneuvance |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Local 2026
via Vaxneuvance |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Care 2026
via Vaxneuvance |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Value 2026
via Vaxneuvance |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Capvaxive |
Tier A - ACA $0 Copay | — | — | — | None |
Cigna
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Cigna Plus NC 4-Tier Formulary 2026 | Tier 2 - Preferred Brand | — | — | — | None |
|
Cigna Plus NC 4-Tier Formulary 2026
via Vaxneuvance |
Tier 2 - Preferred Brand | — | — | — | None |
|
Cigna Plus NC 4-Tier Formulary 2026
via Capvaxive |
Tier 2 - Preferred Brand | — | — | — | None |
NC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 80/20 Plus PPO 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
via Vaxneuvance |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Vaxneuvance |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Vaxneuvance |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
UnitedHealthcare
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UnitedHealthcare NC Individual & Family 2026
via Capvaxive |
Tier 1 - $0 Copay Preventive | — | — | — | None |
|
UnitedHealthcare NC Individual & Family 2026
via Vaxneuvance |
Tier 1 - $0 Copay Preventive | — | — | — month of age or older . | None |
| UnitedHealthcare NC Individual & Family 2026 | Tier 1 - $0 Copay Preventive | — | — | — month of age or older . | None |