quetiapine
100 MG — Tablet
Also known as:
Quetiapine 25 Mg Tablet
Quetiapine 50 Mg Tablet
Quetiapine 100 Mg Tablet
Quetiapine 200 Mg Tablet
Quetiapine 300 Mg Tablet
Quetiapine 400 Mg Tablet
Quetiapine Er 50 Mg Tablet
Quetiapine Er 150 Mg Tablet
Quetiapine Er 200 Mg Tablet
Quetiapine Er 300 Mg Tablet
Quetiapine Er 400 Mg Tablet
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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)
34 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Signature Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Signature Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Signature Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Signature Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Signature Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Signature Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Signature Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Signature Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver $0 Rx Options | Tier 2 - Generic | — | — | — | None |
| Complete Gold | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze | Tier 2 - Generic | — | — | — | None |
| Elite Bronze | Tier 2 - Generic | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | — | None |
| Signature Expanded Bronze | Tier 2 - Generic | — | — | — | None |
| Signature Silver | Tier 2 - Generic | — | — | — | None |
| Signature Gold | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Clear Silver with $0 Insulin Options + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Streamlined Silver | Tier 2 - Generic | — | — | — | None |
| Streamlined Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Enhanced CHF Heart Care Silver $0 Rx Options | Tier 2 - Generic | — | — | — | None |
| Signature Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
AmeriHealth Caritas NC
11 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
Blue Cross Blue Shield Federal
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Seroquel |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Seroquel |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Seroquel |
Tier 1 - Lowest Cost Generic | — | — | ✓ | QL |
|
BCBSNC Blue Advantage 2026
via Seroquel |
Tier 1 - Lowest Cost Generic | — | — | ✓ | QL |
|
BCBSNC Blue Local 2026
via Seroquel |
Tier 1 - Lowest Cost Generic | — | — | ✓ | QL |
|
BCBSNC Blue Care 2026
via Seroquel |
Tier 1 - Lowest Cost Generic | — | — | ✓ | QL |
|
BCBSNC Blue Value 2026
via Seroquel |
Tier 1 - Lowest Cost Generic | — | — | ✓ | QL |
Medicare Part D
140 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Troy Medicare (HMO) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 90 per 30 days | QL |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 90 per 30 days | QL |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 90 per 30 days | QL |
| Senior Care (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 90 per 30 days | QL |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 60 per 30 days | QL |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Signature Extra (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Signature Giveback (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Full Access H5525-034 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HumanaChoice H5525-049 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HumanaChoice H5525-050 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HumanaChoice H5525-070 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HumanaChoice H5525-083 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Erickson Advantage Signature (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Erickson Advantage Freedom (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Erickson Advantage Liberty (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Alignment Health AVA (PPO) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| HealthSpring True Choice (PPO) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| Humana Gold Choice H8145-004 (PFFS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 2 - Generic | ✓ | — | ✓ 120 per 30 days | PA | QL |
| DEVOTED CHOICE 001 NC (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED CHOICE 003 NC (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED CHOICE 005 NC (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED CHOICE 008 NC (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HealthSpring TotalCare (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| HealthSpring Preferred (HMO) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| HealthSpring Preferred Select (HMO) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| HealthSpring Preferred Savings (HMO) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| HealthSpring Preferred Plus (HMO) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| HealthTeam Advantage Plan I (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HealthTeam Advantage Plan II (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus H1036-137 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Wellcare Simple Open (PPO) | Tier 2 - Generic | — | — | — | None |
| Wellcare Giveback Open (PPO) | Tier 2 - Generic | — | — | — | None |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Dual (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Value Plus (HMO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Prime (HMO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Signature Care (HMO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Aetna Medicare Enhanced (HMO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Blue Medicare PPO Enhanced (PPO) | Tier 2 - Generic | ✓ | — | ✓ 120 per 30 days | PA | QL |
| Blue Medicare Essential Plus (HMO-POS) | Tier 2 - Generic | ✓ | — | ✓ 120 per 30 days | PA | QL |
| Blue Medicare Enhanced (HMO-POS) | Tier 2 - Generic | ✓ | — | ✓ 120 per 30 days | PA | QL |
| Blue Medicare Choice (HMO) | Tier 2 - Generic | ✓ | — | ✓ 120 per 30 days | PA | QL |
| Blue Medicare Essential (HMO) | Tier 2 - Generic | ✓ | — | ✓ 120 per 30 days | PA | QL |
| Experience Health Medicare Advantage (HMO) | Tier 2 - Generic | ✓ | — | ✓ 120 per 30 days | PA | QL |
| Wellcare Simple (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| HumanaChoice H5216-211 (PPO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Alignment Health Platinum (HMO) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| Alignment Health smartHMO (HMO) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| Alignment Health Platinum Select (HMO) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 120 per 30 days | QL |
| DEVOTED CORE 001 NC (HMO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 2 - Generic | — | — | ✓ 90 per 30 days | QL |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Assist Open (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - HDHP 2026
via Seroquel |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Seroquel |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Seroquel |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Secure | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Bronze Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | Tier 2 - Generic | — | — | — | None |
| AIAN Cost Share | Tier 2 - Generic | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | Tier 2 - Generic | — | — | — | None |
| Bronze Classic 4700 | Tier 2 - Generic | — | — | — | None |
| Secure | Tier 2 - Generic | — | — | — | None |
| Silver Classic | Tier 2 - Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 2 - Generic | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | Tier 2 - Generic | — | — | — | None |
| Gold Classic Standard | Tier 2 - Generic | — | — | — | None |
| Bronze Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Silver Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Gold Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | — | None |
UnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Standard (HSA, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | ✓ | QL |