Quiofic

Generic: folic acid

0.2 MG/ML — Solution

VITAMINS

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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: 6 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Streamlined Silver
via folic acid 		Tier 0 - $0 Preventive — — — None
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Complete Gold
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Gold
via folic acid 		Tier 0 - $0 Preventive — — — None
Everyday Bronze with Atrium Health
via folic acid 		Tier 0 - $0 Preventive — — — None
Elite Bronze with Atrium Health
via folic acid 		Tier 0 - $0 Preventive — — — None
Focused Silver with Atrium Health
via folic acid 		Tier 0 - $0 Preventive — — — None
Complete Gold with Atrium Health
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze with Atrium Health
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Silver with Atrium Health
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Gold with Atrium Health
via folic acid 		Tier 0 - $0 Preventive — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Complete Gold + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Everyday Bronze + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Elite Bronze + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Silver + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Gold + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Clear Silver with $0 Insulin Options
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Silver
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Silver with Atrium Health + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Signature Gold with Atrium Health + Vision + Adult Dental
via folic acid 		Tier 0 - $0 Preventive — — — None
Everyday Bronze
via folic acid 		Tier 0 - $0 Preventive — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options
via folic acid 		Tier 0 - $0 Preventive — — — None
Elite Bronze
via folic acid 		Tier 0 - $0 Preventive — — — None
Enhanced CHF Heart Care Silver $0 Rx Options
via folic acid 		Tier 0 - $0 Preventive — — — None
Streamlined Silver with Atrium Health
via folic acid 		Tier 0 - $0 Preventive — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 6 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via folic acid 		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 folic acid 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via folic acid 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via folic acid 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via folic acid 		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 folic acid 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals
via folic acid 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via folic acid 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via folic acid 		Tier 1 - Preferred Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via folic acid 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via folic acid 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 6 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via folic acid 		Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026
via folic acid 		Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026
via folic acid 		Tier 1 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 6 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026
via folic acid 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via folic acid 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via folic acid 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via folic acid 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via folic acid 		Tier 1 - Lowest Cost Generic — — — None
Source: PDF  ·  Formulary date: Oct 15, 2026  ·  Checked: 6 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver RD 2200 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Silver 5000 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Silver 3600 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Silver 3000 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect myDiabetesCare Bronze
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect myDiabetesCare Silver
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Gold 1500 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Bronze 6500 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Bronze 5500 Indiv Med Deductible
via folic acid 		Tier 1 - Preferred Generic — — — None
Connect Bronze CMS Standard
via folic acid 		Tier 2 - Generic — — — None
Connect Gold RD CMS Standard
via folic acid 		Tier 2 - Generic — — — None
Connect Silver RD CMS Standard
via folic acid 		Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard
via folic acid 		Tier 2 - Generic — — — None
Connect Gold CMS Standard
via folic acid 		Tier 2 - Generic — — — None
Connect Silver CMS Standard
via folic acid 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 6 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026
via folic acid 		Tier 1 - Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via folic acid 		Tier 1 - Preferred Generic — — — None
NC State Health Plan - HDHP 2026
via folic acid 		Tier 1 - Preferred Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Oct 13, 2026  ·  Checked: 6 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
69803NC0010110
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus
via folic acid 		Tier 2 - Generic — — — None
Silver Classic
via folic acid 		Tier 2 - Generic — — — None
Secure
via folic acid 		Tier 2 - Generic — — — None
Bronze Classic 4700
via folic acid 		Tier 2 - Generic — — — None
Silver Simple PCP Saver
via folic acid 		Tier 2 - Generic — — — None
Silver Simple Diabetes
via folic acid 		Tier 2 - Generic — — — None
Bronze Classic Standard
via folic acid 		Tier 2 - Generic — — — None
Silver Classic Standard
via folic acid 		Tier 2 - Generic — — — None
Gold Classic Standard
via folic acid 		Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Secure | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Silver Classic | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
69803NC0010074
via folic acid 		Tier 2 - Generic — — — None
69803NC0010075
via folic acid 		Tier 2 - Generic — — — None
69803NC0010084
via Folbic 		Tier 2 - Generic — — — None
69803NC0010085
via Folbic 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision
via Folbic 		Tier 2 - Generic — — — None
Bronze Simple Diabetes
via Folbic 		Tier 2 - Generic — — — None
Silver Core Plan
via Folbic 		Tier 2 - Generic — — — None
Silver Core Plan | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Silver Simple Diabetes with Adult Dental & Vision
via Folbic 		Tier 2 - Generic — — — None
69803NC0010108
via Folbic 		Tier 2 - Generic — — — None
69803NC0010109
via Folbic 		Tier 2 - Generic — — — None
69803NC0010110
via Folbic 		Tier 2 - Generic — — — None
69803NC0010111
via Folbic 		Tier 2 - Generic — — — None
69803NC0010112
via Folbic 		Tier 2 - Generic — — — None
69803NC0010113
via Folbic 		Tier 2 - Generic — — — None
69803NC0010114
via Folbic 		Tier 2 - Generic — — — None
69803NC0010115
via Folbic 		Tier 2 - Generic — — — None
69803NC0010116
via Folbic 		Tier 2 - Generic — — — None
69803NC0010117
via Folbic 		Tier 2 - Generic — — — None
Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
69803NC0010076
via folic acid 		Tier 2 - Generic — — — None
69803NC0010077
via folic acid 		Tier 2 - Generic — — — None
69803NC0010078
via folic acid 		Tier 2 - Generic — — — None
69803NC0010079
via folic acid 		Tier 2 - Generic — — — None
69803NC0010080
via folic acid 		Tier 2 - Generic — — — None
69803NC0010081
via folic acid 		Tier 2 - Generic — — — None
69803NC0010082
via folic acid 		Tier 2 - Generic — — — None
69803NC0010083
via folic acid 		Tier 2 - Generic — — — None
69803NC0010084
via folic acid 		Tier 2 - Generic — — — None
69803NC0010085
via folic acid 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision
via folic acid 		Tier 2 - Generic — — — None
Bronze Simple Diabetes
via folic acid 		Tier 2 - Generic — — — None
Silver Core Plan
via folic acid 		Tier 2 - Generic — — — None
Silver Core Plan | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Silver Simple Diabetes with Adult Dental & Vision
via folic acid 		Tier 2 - Generic — — — None
69803NC0010108
via folic acid 		Tier 2 - Generic — — — None
69803NC0010109
via folic acid 		Tier 2 - Generic — — — None
69803NC0010110
via folic acid 		Tier 2 - Generic — — — None
69803NC0010111
via folic acid 		Tier 2 - Generic — — — None
69803NC0010112
via folic acid 		Tier 2 - Generic — — — None
69803NC0010113
via folic acid 		Tier 2 - Generic — — — None
69803NC0010114
via folic acid 		Tier 2 - Generic — — — None
69803NC0010115
via folic acid 		Tier 2 - Generic — — — None
69803NC0010116
via folic acid 		Tier 2 - Generic — — — None
69803NC0010117
via folic acid 		Tier 2 - Generic — — — None
Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health
via folic acid 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Classic
via Niva-Fol 		Tier 2 - Generic — — — None
Secure
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Classic 4700
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Simple PCP Saver
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Simple Diabetes
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Classic Standard
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Classic Standard
via Niva-Fol 		Tier 2 - Generic — — — None
Gold Classic Standard
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Secure | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Classic | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010074
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010075
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010076
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010077
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010078
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010079
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010080
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010081
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010082
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010083
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010084
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010085
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Simple Diabetes
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Core Plan
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Core Plan | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Simple Diabetes with Adult Dental & Vision
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010108
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010109
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010111
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010112
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010113
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010114
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010115
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010116
via Niva-Fol 		Tier 2 - Generic — — — None
69803NC0010117
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health
via Niva-Fol 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus
via Folbic 		Tier 2 - Generic — — — None
Silver Classic
via Folbic 		Tier 2 - Generic — — — None
Secure
via Folbic 		Tier 2 - Generic — — — None
Bronze Classic 4700
via Folbic 		Tier 2 - Generic — — — None
Silver Simple PCP Saver
via Folbic 		Tier 2 - Generic — — — None
Silver Simple Diabetes
via Folbic 		Tier 2 - Generic — — — None
Bronze Classic Standard
via Folbic 		Tier 2 - Generic — — — None
Silver Classic Standard
via Folbic 		Tier 2 - Generic — — — None
Gold Classic Standard
via Folbic 		Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Secure | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Silver Classic | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
69803NC0010074
via Folbic 		Tier 2 - Generic — — — None
69803NC0010075
via Folbic 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health
via Folbic 		Tier 2 - Generic — — — None
69803NC0010076
via Folbic 		Tier 2 - Generic — — — None
69803NC0010077
via Folbic 		Tier 2 - Generic — — — None
69803NC0010078
via Folbic 		Tier 2 - Generic — — — None
69803NC0010079
via Folbic 		Tier 2 - Generic — — — None
69803NC0010080
via Folbic 		Tier 2 - Generic — — — None
69803NC0010081
via Folbic 		Tier 2 - Generic — — — None
69803NC0010082
via Folbic 		Tier 2 - Generic — — — None
69803NC0010083
via Folbic 		Tier 2 - Generic — — — None
Source: Excel (XLSX)  ·  Formulary date: Sep 23, 2026  ·  Checked: 6 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via folic acid 		Tier 1 - Generic Formulary (Basic Core) ✓ — — PA PA on 1 of 100 NDCs: TPA - SELECT DRUGS REQUIRES PRIOR AUTHORIZATION (NEW TO MARKET DRUGS)
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary ✓ — — PA PA: TPA - SELECT DRUGS REQUIRES PRIOR AUTHORIZATION (NEW TO MARKET DRUGS)
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 6 hours, 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via folic acid 		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 folic acid 		Tier 1 - Preferred Generic — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via folic acid 		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 folic acid 		Tier 1 - Preferred Generic — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via folic acid 		Tier 1 - Preferred Generic — — — None
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