Simlandi 1-Pen
Generic: adalimumab-ryvk
40MG/0.4ML, 80MG/0.8ML — Pen Injector
ANALGESICS - ANTI-INFLAMMATORY
Also known as:
SIMLANDI 1-PEN KIT AJKT 40MG/0.4ML, 80MG/0.8ML
Simlandi 1-Pen Kit
SIMLANDI 1-PEN KIT AJKT 40MG/0.4ML,
Compare Prices
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 |
|---|---|---|---|---|---|
|
Signature Expanded Bronze with Atrium Health
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Streamlined Silver
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Streamlined Silver with Atrium Health
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver with Atrium Health
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold with Atrium Health
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
AmeriHealth Caritas NC
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via adalimumab-ryvk |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via adalimumab-ryvk |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via adalimumab-ryvk |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via adalimumab-ryvk |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via adalimumab-ryvk |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via adalimumab-ryvk |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via adalimumab-ryvk |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via adalimumab-ryvk |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Simlandi |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via adalimumab-ryvk |
Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
15 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Advantage 2026
via Simlandi 2-Pen |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Advantage 2026
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Local 2026
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Care 2026
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Value 2026
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Advantage 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Local 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Care 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Value 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Simlandi 2-Pen |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Local 2026
via Simlandi 2-Pen |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Care 2026
via Simlandi 2-Pen |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Value 2026
via Simlandi 2-Pen |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
Cigna
40 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Silver 5000 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 5500 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 6500 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Bronze
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold CMS Standard
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 5000 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 6000 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD CMS Standard
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 3500 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 5000 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver CMS Standard
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze CMS Standard
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3000 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3600 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD CMS Standard
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 2200 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold RD CMS Standard
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 5000 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 5500 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 6500 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold RD CMS Standard
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 2200 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold 1500 Indiv Med Deductible
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD CMS Standard
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 5000 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 3500 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD CMS Standard
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 6000 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 5000 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold 1500 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Silver
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Bronze
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold CMS Standard
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver CMS Standard
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze CMS Standard
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Silver
via ADALIMUMAB-RYVK(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3000 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3600 Indiv Med Deductible
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
Medicare Part D
48 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Longevity Health Plan (HMO I-SNP)
via SIMLANDI(CF) |
Tier 1 - Preferred Generic | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
NHC Advantage (HMO I-SNP)
via Simlandi |
Tier 1 - Preferred Generic | ✓ | — | ✓ 6 per 28 days | PA | QL |
|
NHC Advantage (HMO I-SNP)
via SIMLANDI(CF) |
Tier 1 - Preferred Generic | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
PruittHealth Premier (HMO I-SNP)
via SIMLANDI(CF) |
Tier 1 - Preferred Generic | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via SIMLANDI(CF) |
Tier 1 - Preferred Generic | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via SIMLANDI(CF) |
Tier 1 - Preferred Generic | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Simlandi |
Tier 1 - Preferred Generic | ✓ | — | ✓ 6 per 28 days | PA | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Simlandi |
Tier 1 - Preferred Generic | ✓ | — | ✓ 6 per 28 days | PA | QL |
|
PruittHealth Premier (HMO I-SNP)
via Simlandi |
Tier 1 - Preferred Generic | ✓ | — | ✓ 6 per 28 days | PA | QL |
|
Longevity Health Plan (HMO I-SNP)
via Simlandi |
Tier 1 - Preferred Generic | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Troy Medicare (HMO)
via SIMLANDI(CF) |
Tier 3 - Preferred Brand | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via SIMLANDI(CF) |
Tier 3 - Preferred Brand | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via SIMLANDI(CF) |
Tier 3 - Preferred Brand | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Troy Medicare (HMO)
via Simlandi |
Tier 3 - Preferred Brand | ✓ | — | ✓ 6 per 28 days | PA | QL |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Simlandi |
Tier 3 - Preferred Brand | ✓ | — | ✓ 6 per 28 days | PA | QL |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Simlandi |
Tier 3 - Preferred Brand | ✓ | — | ✓ 6 per 28 days | PA | QL |
|
Senior Care (HMO I-SNP)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Experience Health Medicare Advantage (HMO)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Blue Medicare Essential (HMO)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Blue Medicare Choice (HMO)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Blue Medicare Enhanced (HMO-POS)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Blue Medicare Essential Plus (HMO-POS)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Blue Medicare PPO Enhanced (PPO)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Blue Medicare PPO Enhanced (PPO)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Blue Medicare Essential Plus (HMO-POS)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Blue Medicare Enhanced (HMO-POS)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Blue Medicare Choice (HMO)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Blue Medicare Essential (HMO)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Experience Health Medicare Advantage (HMO)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Senior Care (HMO I-SNP)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 6 per 28 days | PA | QL |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 6 per 28 days | PA | QL |
|
Alignment Health AVA (PPO)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Alignment Health Platinum (HMO)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Alignment Health smartHMO (HMO)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Alignment Health Platinum Select (HMO)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Alignment Health Platinum Select (HMO)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Alignment Health AVA (PPO)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via SIMLANDI(CF) |
Tier 5 - Specialty | ✓ | — | ✓ 2 per 28 days | PA | QL |
|
Alignment Health Platinum (HMO)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Alignment Health smartHMO (HMO)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Simlandi |
Tier 5 - Specialty | ✓ | — | ✓ 4 per 28 days | PA | QL |
NC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 70/30 Standard PPO 2026
via Simlandi 2-Pen |
Not Covered | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Simlandi 2-Pen |
Not Covered | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Simlandi 2-Pen |
Not Covered | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Not Covered | — | — | — | None |