propranolol hcl

10 mg, 20 mg, 40 mg, 60 mg, 80 mg — Capsule

ANTIANGINAL AGENTS

Also known as: propranolol hcl oral propranolol hcl soln 1mg/ml propranolol hcl cap er 24hr 60 mg, 80 mg, 120 mg, 160 mg propranolol hcl tab 10 mg, 20 mg, 40 mg, 60 mg, 80 mg Propranolol HCl Oral Tablet Propranolol HCl ER Oral Capsule Extended Release Propranolol HCl Oral Solution propranolol hcl oral soln 20 mg/5ml
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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: 5 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Complete Gold + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Everyday Bronze + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Elite Bronze + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Gold with Atrium Health + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Silver with Atrium Health + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Streamlined Silver
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Streamlined Silver with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Enhanced CHF Heart Care Silver $0 Rx Options
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Silver + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Gold + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Expanded Bronze + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Everyday Bronze
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Elite Bronze
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Expanded Bronze
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Silver
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Gold
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Expanded Bronze with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Silver with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Complete Gold
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Signature Gold with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 5 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 5 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Inderal La 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Inderal La 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Inderal La 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Inderal La 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Inderal La 		Tier 1 - Lowest Cost Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 5 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Erickson Advantage Champion (HMO-POS C-SNP) Tier 1 - Preferred Generic — — — None
Erickson Advantage Signature (HMO-POS) Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 1 - Preferred Generic — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
Troy Medicare (HMO)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 1 - Preferred Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Troy Medicare (HMO) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Senior Care (HMO I-SNP) Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Aetna Medicare Chronic Care (HMO C-SNP) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 1 - Preferred Generic — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 1 - Preferred Generic — — — None
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 1 - Preferred Generic — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 1 - Preferred Generic — — — None
HealthSpring Preferred Plus (HMO) Tier 1 - Preferred Generic — — — None
HealthSpring Preferred Savings (HMO) Tier 1 - Preferred Generic — — — None
HealthSpring Preferred Select (HMO) Tier 1 - Preferred Generic — — — None
HealthSpring Preferred (HMO) Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 1 - Preferred Generic — — — None
HealthSpring True Choice (PPO) Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
Aetna Medicare Chronic Care (HMO C-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Erickson Advantage Liberty (HMO-POS) Tier 1 - Preferred Generic — — — None
Erickson Advantage Freedom (HMO-POS) Tier 1 - Preferred Generic — — — None
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 1 - Preferred Generic — — — None
Alignment Health AVA (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
UHC Dual Complete NC-S001 (PPO D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
UHC Dual Complete NC-S2 (PPO D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Wellcare Simple Open (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Wellcare Dual Liberty Open (PPO D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Wellcare Assist Open (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Wellcare Giveback Open (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Dual (HMO D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Value Plus (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Prime (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Signature Care (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Full Dual Care (HMO D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Blue Medicare PPO Enhanced (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Blue Medicare Essential Plus (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Blue Medicare Enhanced (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Blue Medicare Choice (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Blue Medicare Essential (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Experience Health Medicare Advantage (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Wellcare Simple (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Wellcare Dual Access (HMO-POS D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Wellcare Dual Reserve (HMO-POS D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Wellcare Dual Liberty (HMO-POS D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Senior Care (HMO I-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Alignment Health Platinum (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Alignment Health NC Duals (HMO-POS D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Alignment Health smartHMO (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Alignment Health Platinum Select (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Signature Extra (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Signature Giveback (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Erickson Advantage Signature (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Erickson Advantage Guardian (HMO-POS I-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Erickson Advantage Champion (HMO-POS C-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Erickson Advantage Freedom (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Erickson Advantage Liberty (HMO-POS)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Liberty Medicare Advantage (HMO C-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
HealthSpring True Choice (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Healthy Blue + Medicare (HMO-POS D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
HealthSpring TotalCare (HMO D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
HealthSpring Preferred (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
HealthSpring Preferred Select (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
HealthSpring Preferred Savings (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
HealthSpring Preferred Plus (HMO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
HealthTeam Advantage Plan I (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
HealthTeam Advantage Plan II (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
HealthTeam Advantage Vitality Plan (PPO)
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Humana Gold Plus H1036-137 (HMO-POS) Tier 2 - Generic — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 2 - Generic — — — None
Humana Gold Plus H1036-233 (HMO-POS) Tier 2 - Generic — — — None
Humana Dual Select H1036-307 (HMO D-SNP) Tier 2 - Generic — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 2 - Generic — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 2 - Generic — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 2 - Generic — — — None
Humana Gold Plus H1036-335 (HMO-POS) Tier 2 - Generic — — — None
Wellcare Simple Open (PPO) Tier 2 - Generic — — — None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 2 - Generic — — — None
Wellcare Assist Open (PPO) Tier 2 - Generic — — — None
Wellcare Giveback Open (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO) Tier 2 - Generic — — — None
Aetna Medicare Dual (HMO D-SNP) Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO) Tier 2 - Generic — — — None
Aetna Medicare Value Plus (HMO) Tier 2 - Generic — — — None
Aetna Medicare Prime (HMO) Tier 2 - Generic — — — None
Aetna Medicare Signature Care (HMO) Tier 2 - Generic — — — None
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (HMO) Tier 2 - Generic — — — None
Blue Medicare PPO Enhanced (PPO) Tier 2 - Generic — — — None
Blue Medicare Essential Plus (HMO-POS) Tier 2 - Generic — — — None
Blue Medicare Enhanced (HMO-POS) Tier 2 - Generic — — — None
Blue Medicare Choice (HMO) Tier 2 - Generic — — — None
Blue Medicare Essential (HMO) Tier 2 - Generic — — — None
Experience Health Medicare Advantage (HMO) Tier 2 - Generic — — — None
Wellcare Simple (HMO-POS) Tier 2 - Generic — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 2 - Generic — — — None
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 2 - Generic — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 2 - Generic — — — None
HumanaChoice Giveback H5216-017 (PPO) Tier 2 - Generic — — — None
HumanaChoice H5216-211 (PPO) Tier 2 - Generic — — — None
Alignment Health Platinum (HMO) Tier 2 - Generic — — — None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 2 - Generic — — — None
Alignment Health smartHMO (HMO) Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 2 - Generic — — — None
Alignment Health Platinum Select (HMO) Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 2 - Generic — — — None
DEVOTED CORE 001 NC (HMO) Tier 2 - Generic — — — None
DEVOTED GIVEBACK 002 NC (HMO) Tier 2 - Generic — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 2 - Generic — — — None
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 2 - Generic — — — None
DEVOTED GIVEBACK 012 NC (HMO) Tier 2 - Generic — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 2 - Generic — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 2 - Generic — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 2 - Generic — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 2 - Generic — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 2 - Generic — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature Extra (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature Giveback (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Humana Full Access H5525-034 (PPO) Tier 2 - Generic — — — None
HumanaChoice Giveback H5525-035 (PPO) Tier 2 - Generic — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 2 - Generic — — — None
HumanaChoice H5525-049 (PPO) Tier 2 - Generic — — — None
HumanaChoice H5525-050 (PPO) Tier 2 - Generic — — — None
HumanaChoice H5525-070 (PPO) Tier 2 - Generic — — — None
Humana Dual Select H5525-072 (PPO D-SNP) Tier 2 - Generic — — — None
HumanaChoice H5525-083 (PPO) Tier 2 - Generic — — — None
Humana Gold Plus H6622-025 (HMO-POS) Tier 2 - Generic — — — None
Humana Gold Plus H6622-026 (HMO-POS) Tier 2 - Generic — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 2 - Generic — — — None
Humana Gold Plus H6622-057 (HMO-POS) Tier 2 - Generic — — — None
Humana Gold Plus H6622-060 (HMO-POS) Tier 2 - Generic — — — None
Humana Gold Plus H6622-061 (HMO-POS) Tier 2 - Generic — — — None
Alignment Health AVA (PPO) Tier 2 - Generic — — — None
Humana Gold Choice H8145-004 (PFFS) Tier 2 - Generic — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 2 - Generic — — — None
DEVOTED CHOICE 001 NC (PPO) Tier 2 - Generic — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 2 - Generic — — — None
DEVOTED CHOICE 003 NC (PPO) Tier 2 - Generic — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 2 - Generic — — — None
DEVOTED CHOICE 005 NC (PPO) Tier 2 - Generic — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 2 - Generic — — — None
DEVOTED CHOICE 008 NC (PPO) Tier 2 - Generic — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 2 - Generic — — — None
HealthTeam Advantage Plan I (PPO) Tier 2 - Generic — — — None
HealthTeam Advantage Plan II (PPO) Tier 2 - Generic — — — None
HealthTeam Advantage Vitality Plan (PPO) Tier 2 - Generic — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Choice H8145-004 (PFFS)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-061 (HMO-POS)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-060 (HMO-POS)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-057 (HMO-POS)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-026 (HMO-POS)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-070 (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-050 (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-049 (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5525-035 (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Full Access H5525-034 (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-137 (HMO-POS)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 002 NC (HMO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-025 (HMO-POS)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED CORE 001 NC (HMO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5216-211 (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5216-017 (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-335 (HMO-POS)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H1036-307 (HMO D-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 012 NC (HMO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-233 (HMO-POS)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-083 (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H5525-072 (PPO D-SNP)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 008 NC (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 005 NC (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 003 NC (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 001 NC (PPO)
via propranolol hydrochloride 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 6 - Specialty Plus — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via propranolol hydrochloride 		Tier 6 - Specialty Plus — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 5 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic — — — None
Source: CMS QHP JSON  ·  Checked: 5 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Classic Standard
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Bronze Classic 4700
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Secure
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Silver Classic
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AIAN Cost Share | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Bronze Classic Standard
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Silver Simple Diabetes
via propranolol hydrochloride 		Tier 2 - Generic — — — None
AIAN Cost Share
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Gold Elite Saver Plus | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Gold Elite Saver Plus
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Silver Simple PCP Saver
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Silver Classic | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Secure | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Gold Classic Standard
via propranolol hydrochloride 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 5 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via propranolol hydrochloride 		Tier 1 - Preferred Generic — — — None
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