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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.
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Advantage 2026
via nicotine polacrilex |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via nicotine polacrilex |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Local 2026
via nicotine polacrilex |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Care 2026
via nicotine polacrilex |
Tier A - ACA $0 Copay | — | — | — | None |
|
BCBSNC Blue Value 2026
via nicotine polacrilex |
Tier A - ACA $0 Copay | — | — | — | None |
TRICARE
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
TRICARE Uniform Formulary 2026
via nicotine polacrilex |
Tier 1 - Generic Formulary (Basic Core) | — | — | — | None |
| TRICARE Uniform Formulary 2026 | Tier 1 - Generic Formulary | — | — | ✓ 1270/99001/156693 DOD HCR SMOK CESS SCP158 DY/DY | QL Quantity limit on 3 of 4 NDCs |
|
TRICARE Uniform Formulary 2026
via Quit 4 |
Tier 2 - Brand Formulary (Basic Core) | — | — | ✓ 1270/99001/156693 DOD HCR SMOK CESS SCP158 DY/DY | QL Quantity limit on 1 of 2 NDCs |