Sf 5000 Plus

Generic: sodium fluoride

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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: 17 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Gold + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Complete Gold
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Everyday Bronze
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Silver + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Elite Bronze with Atrium Health
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Focused Silver with Atrium Health
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Complete Gold with Atrium Health
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Expanded Bronze with Atrium Health
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Silver with Atrium Health
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Gold with Atrium Health
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Elite Bronze
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Clear Silver with $0 Insulin Options
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Expanded Bronze
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Silver
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Gold
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Everyday Bronze with Atrium Health
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Complete Gold + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Elite Bronze + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental
via sodium fluoride 		Tier 0 - $0 Preventive — — ✓ QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via Dentagel 		Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026
via Sodium Fluoride 5000 Ppm 		Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026
via Dentagel 		Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026
via Sodium Fluoride 5000 Ppm 		Tier 1 - Generic — — — None
BCBS Federal Focus 2026
via Dentagel 		Tier 1 - Generic — — — None
BCBS Federal Focus 2026
via Sodium Fluoride 5000 Ppm 		Tier 1 - Generic — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 19 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026
via Just Right 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via sodium fluoride 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via sodium fluoride 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via sodium fluoride 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via sodium fluoride 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Sodium Fluoride 5000 Plus 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Sodium Fluoride 5000 Plus 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Sodium Fluoride 5000 Plus 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Sodium Fluoride 5000 Plus 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Sodium Fluoride 5000 Plus 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Sodium Fluoride 5000 Ppm 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Sodium Fluoride 5000 Ppm 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Sodium Fluoride 5000 Ppm 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Sodium Fluoride 5000 Ppm 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Sodium Fluoride 5000 Ppm 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via sodium fluoride 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Clinpro 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Clinpro 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Clinpro 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Clinpro 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Clinpro 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Denta 5000 Plus 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Denta 5000 Plus 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Denta 5000 Plus 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Denta 5000 Plus 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Denta 5000 Plus 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Dentagel 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Dentagel 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Dentagel 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Dentagel 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Dentagel 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Fluoridex Daily Defense 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Fluoridex Daily Defense 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Fluoridex Daily Defense 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Fluoridex Daily Defense 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Fluoridex Daily Defense 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Fluoridex Enhanced Whiten 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Fluoridex Enhanced Whiten 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Fluoridex Enhanced Whiten 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Fluoridex Enhanced Whiten 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Fluoridex Enhanced Whiten 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Fluorimax 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Fluorimax 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Fluorimax 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Fluorimax 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Fluorimax 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Just Right 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Just Right 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Just Right 5000 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Just Right 5000 		Tier 1 - Lowest Cost Generic — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026
via sodium fluoride 		Tier 1 - $0 Copay Preventive — — — members ages 0 to 16 years . None
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