Sodium Fluoride 5000 Ppm
Generic: sodium fluoride
1.1% — Gel
Also known as:
sodium fluoride 5000 ppm gel 1.1%; pste 1.1%
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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.
Ambetter (Centene)
29 plans| 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 |
Blue Cross Blue Shield Federal
6 plans| 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 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Dentagel |
Tier 1 - Generic | — | — | — | None |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Focus 2026
via Dentagel |
Tier 1 - Generic | — | — | — | None |
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — | None |
Blue Cross Blue Shield of NC
55 plans| 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
via Sf 5000 Plus |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Sf 5000 Plus |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Local 2026
via Sf 5000 Plus |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Care 2026
via Sf 5000 Plus |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Value 2026
via Sf 5000 Plus |
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 | 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 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 |