Renthyroid

Generic: thyroid

15MG, 30MG, 45MG, 60MG, 75MG, 90MG, 120MG — Tablet

ANTIDIABETICS

Also known as: RENTHYROID TABS 15MG, 30MG, 45MG, 60MG, 75MG, 90MG, 120MG RENTHYROID TABS 15MG, 30MG, 45MG,

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: 19 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Gold + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Silver + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Gold with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Silver with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Complete Gold with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Everyday Bronze with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Gold
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Silver
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze
via Evexithroid
Tier 3 - Preferred Brand QL
Clear Silver with $0 Insulin Options
via Evexithroid
Tier 3 - Preferred Brand QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Elite Bronze + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Everyday Bronze + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Complete Gold + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Gold with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Silver with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Complete Gold
via Evexithroid
Tier 3 - Preferred Brand QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Evexithroid
Tier 3 - Preferred Brand QL
Everyday Bronze
via Evexithroid
Tier 3 - Preferred Brand QL
Elite Bronze
via Evexithroid
Tier 3 - Preferred Brand QL
Elite Bronze with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Focused Silver with Atrium Health
via Evexithroid
Tier 3 - Preferred Brand QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Complete Gold + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Everyday Bronze + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Elite Bronze + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Complete Gold
via Armour Thyroid
Tier 3 - Preferred Brand QL
Everyday Bronze
via Armour Thyroid
Tier 3 - Preferred Brand QL
Elite Bronze
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Silver + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Gold + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Everyday Bronze with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Gold
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Silver
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Expanded Bronze
via Armour Thyroid
Tier 3 - Preferred Brand QL
Clear Silver with $0 Insulin Options
via Armour Thyroid
Tier 3 - Preferred Brand QL
Standard Silver with Atrium Health + Vision + Adult Dental
via Evexithroid
Tier 3 - Preferred Brand QL
Standard Silver with Atrium Health + Vision + Adult Dental
via Armour Thyroid
Tier 3 - Preferred Brand QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Armour Thyroid
Tier 3 - Preferred Brand QL
Complete Gold with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Focused Silver with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Elite Bronze with Atrium Health
via Armour Thyroid
Tier 3 - Preferred Brand QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 19 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via Thyroid
Tier 2 - Preferred Brand None
BCBS Federal Focus 2026
via Armour Thyroid
Tier 2 - Preferred Brand None
BCBS Federal Standard Option 2026
via Armour Thyroid
Tier 3 - Non-Preferred Brand None
BCBS Federal Standard Option 2026
via Thyroid
Tier 3 - Non-Preferred Brand None
BCBS Federal Basic Option 2026
via Thyroid
Tier 3 - Non-Preferred Brand None
BCBS Federal Basic Option 2026
via Armour Thyroid
Tier 3 - Non-Preferred Brand None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 19 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via Np Thyroid 90
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Armour Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Armour Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Armour Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Armour Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Armour Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Evexithroid
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Evexithroid
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Evexithroid
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Evexithroid
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Evexithroid
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Niva Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Niva Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Niva Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Niva Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Niva Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Np Thyroid 120
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Np Thyroid 120
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Np Thyroid 120
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Np Thyroid 120
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Np Thyroid 120
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Np Thyroid 15
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Np Thyroid 15
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Np Thyroid 15
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Np Thyroid 15
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Np Thyroid 15
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Np Thyroid 30
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Np Thyroid 30
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Np Thyroid 30
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Np Thyroid 30
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Np Thyroid 30
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Np Thyroid 60
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Np Thyroid 60
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Np Thyroid 60
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Np Thyroid 60
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Np Thyroid 60
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Np Thyroid 90
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Np Thyroid 90
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Np Thyroid 90
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Np Thyroid 90
Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026 Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026 Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026 Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026 Tier 3 - High Cost Brand None
BCBSNC Blue Advantage 2026
via Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Local 2026
via Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Care 2026
via Thyroid
Tier 3 - High Cost Brand None
BCBSNC Blue Value 2026
via Thyroid
Tier 3 - High Cost Brand None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 19 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 6500 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect Silver CMS Standard
via Niva Thyroid
Tier 2 - Generic None
Connect Silver RD CMS Standard
via Niva Thyroid
Tier 2 - Generic None
Connect Gold CMS Standard
via Niva Thyroid
Tier 2 - Generic None
Connect Bronze RD CMS Standard
via Niva Thyroid
Tier 2 - Generic None
Connect Gold RD CMS Standard
via Niva Thyroid
Tier 2 - Generic None
Connect Bronze CMS Standard
via Niva Thyroid
Tier 2 - Generic None
Connect Silver 3500 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect Bronze RD 5000 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect Silver RD 3500 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect Bronze 7000 HSA Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect Silver RD 2200 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Gold 1500 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect myDiabetesCare Bronze
via Thyroid
Tier 2 - Generic None
Connect Bronze 5500 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Bronze RD 6000 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Silver 3500 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Bronze RD 5000 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Silver RD 3500 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Bronze 7000 HSA Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Silver 4400 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Silver RD 5000 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Silver 3000 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect Bronze 6500 Indiv Med Deductible
via Thyroid
Tier 2 - Generic None
Connect myDiabetesCare Silver
via Niva Thyroid
Tier 2 - Generic None
Connect Silver RD 2200 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect Gold 1500 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect myDiabetesCare Bronze
via Niva Thyroid
Tier 2 - Generic None
Connect Bronze 5500 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect Bronze RD 6000 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect myDiabetesCare Silver
via Thyroid
Tier 2 - Generic None
Connect Silver 4400 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect Silver RD 5000 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect Silver 3000 Indiv Med Deductible
via Niva Thyroid
Tier 2 - Generic None
Connect Silver CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Silver RD CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Gold CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Bronze RD CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Gold RD CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Bronze CMS Standard
via Thyroid
Tier 2 - Generic None
Connect Silver 3500 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver 3000 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver RD 5000 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver 4400 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver RD CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Gold CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze RD CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Gold RD CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze CMS Standard
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze 7000 HSA Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver RD 3500 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze RD 5000 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze 6500 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze RD 6000 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Bronze 5500 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect myDiabetesCare Bronze
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Gold 1500 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect Silver RD 2200 Indiv Med Deductible
via Armour Thyroid
Tier 3 - Preferred Brand None
Connect myDiabetesCare Silver
via Armour Thyroid
Tier 3 - Preferred Brand None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 19 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026
via Np Thyroid 120
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Np Thyroid 60
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via Np Thyroid 60
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Np Thyroid 60
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Np Thyroid 90
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via Np Thyroid 90
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Np Thyroid 90
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Np Thyroid 120
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Np Thyroid 15
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Np Thyroid 120
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Armour Thyroid
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via Np Thyroid 15
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Armour Thyroid
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via Armour Thyroid
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Np Thyroid 15
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026
via Np Thyroid 30
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 70/30 Standard PPO 2026
via Np Thyroid 30
Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026
via Np Thyroid 30
Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered None
NC State Health Plan - HDHP 2026 Not Covered None
NC State Health Plan - 80/20 Plus PPO 2026
via Thyroid
Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026
via Thyroid
Not Covered None
NC State Health Plan - HDHP 2026
via Thyroid
Not Covered None
NC State Health Plan - HDHP 2026
via Evexithroid
Not Covered None
NC State Health Plan - 80/20 Plus PPO 2026
via Evexithroid
Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026
via Evexithroid
Not Covered None
Source: CMS QHP JSON  ·  Checked: 19 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Gold Classic Standard
via Armour Thyroid
Tier 2 - Generic None
Bronze Classic Standard | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Classic Standard | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Gold Classic Standard | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Elite + PCP Saver Plus
via Armour Thyroid
Tier 2 - Generic None
Silver Classic
via Armour Thyroid
Tier 2 - Generic None
Secure
via Armour Thyroid
Tier 2 - Generic None
Bronze Classic 4700
via Armour Thyroid
Tier 2 - Generic None
Silver Simple PCP Saver
via Armour Thyroid
Tier 2 - Generic None
Gold Elite Saver Plus
via Armour Thyroid
Tier 2 - Generic None
Silver Simple Diabetes
via Armour Thyroid
Tier 2 - Generic None
Secure | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Classic 4700 | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Elite + PCP Saver Plus | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Classic | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Simple Diabetes | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Simple PCP Saver | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Gold Elite Saver Plus | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Simple Chronic Care CKM | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Simple Diabetes | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Simple Chronic Care CKM | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
AIAN Cost Share
via Armour Thyroid
Tier 2 - Generic None
AIAN Cost Share | with Atrium Health
via Armour Thyroid
Tier 2 - Generic None
Bronze Classic Standard
via Armour Thyroid
Tier 2 - Generic None
Silver Classic Standard
via Armour Thyroid
Tier 2 - Generic None
AIAN Cost Share
via Niva Thyroid
Tier 2 - Generic None
AIAN Cost Share | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Silver Classic | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Silver Simple Diabetes | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Silver Simple PCP Saver | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Gold Elite Saver Plus | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Bronze Simple Chronic Care CKM | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Bronze Simple Diabetes | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Silver Simple Chronic Care CKM | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Bronze Classic Standard
via Niva Thyroid
Tier 2 - Generic None
Silver Classic Standard
via Niva Thyroid
Tier 2 - Generic None
Gold Classic Standard
via Niva Thyroid
Tier 2 - Generic None
Bronze Classic Standard | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Silver Classic Standard | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Gold Classic Standard | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Bronze Elite + PCP Saver Plus
via Niva Thyroid
Tier 2 - Generic None
Silver Classic
via Niva Thyroid
Tier 2 - Generic None
Secure
via Niva Thyroid
Tier 2 - Generic None
Bronze Classic 4700
via Niva Thyroid
Tier 2 - Generic None
Silver Simple PCP Saver
via Niva Thyroid
Tier 2 - Generic None
Gold Elite Saver Plus
via Niva Thyroid
Tier 2 - Generic None
Silver Simple Diabetes
via Niva Thyroid
Tier 2 - Generic None
Secure | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Bronze Classic 4700 | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Bronze Elite + PCP Saver Plus | with Atrium Health
via Niva Thyroid
Tier 2 - Generic None
Bronze Classic Standard
via thyroid (USP)
Tier 2 - Generic None
Silver Classic Standard
via thyroid (USP)
Tier 2 - Generic None
Gold Classic Standard
via thyroid (USP)
Tier 2 - Generic None
Bronze Classic Standard | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Classic Standard | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Gold Classic Standard | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Bronze Elite + PCP Saver Plus
via thyroid (USP)
Tier 2 - Generic None
Silver Classic
via thyroid (USP)
Tier 2 - Generic None
Secure
via thyroid (USP)
Tier 2 - Generic None
Bronze Classic 4700
via thyroid (USP)
Tier 2 - Generic None
Silver Simple PCP Saver
via thyroid (USP)
Tier 2 - Generic None
Gold Elite Saver Plus
via thyroid (USP)
Tier 2 - Generic None
Silver Simple Diabetes
via thyroid (USP)
Tier 2 - Generic None
Secure | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Bronze Classic 4700 | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Bronze Elite + PCP Saver Plus | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Classic | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Simple Diabetes | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Simple PCP Saver | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Gold Elite Saver Plus | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Bronze Simple Chronic Care CKM | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Bronze Simple Diabetes | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Simple Chronic Care CKM | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
AIAN Cost Share
via thyroid (USP)
Tier 2 - Generic None
AIAN Cost Share | with Atrium Health
via thyroid (USP)
Tier 2 - Generic None
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 19 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Gold Standard (No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Bronze Standard+ Dental + Vision (No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Silver Standard (No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Bronze Standard (No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via thyroid (USP)
Tier 4 - Non-Preferred None
UHC Bronze Standard (No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Silver Standard (No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Gold Standard (No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Standard+ Dental + Vision (No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via Niva Thyroid
Tier 4 - Non-Preferred None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Silver Standard (No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Standard (No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Gold Standard (No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
UHC Bronze Standard+ Dental + Vision (No Referrals)
via Armour Thyroid
Tier 4 - Non-Preferred None
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