Soft Gelatin methoxsalen

10 MG — Capsule

Psoralen

GoodRx Compare Prices

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: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Signature Expanded Bronze Tier 2 - Generic — — ✓ QL
Signature Silver Tier 2 - Generic — — ✓ QL
Signature Gold Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Signature Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Streamlined Silver Tier 2 - Generic — — ✓ QL
Streamlined Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Enhanced CHF Heart Care Silver $0 Rx Options Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Elite Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Complete Gold Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver $0 Rx Options Tier 2 - Generic — — ✓ QL
Everyday Bronze Tier 2 - Generic — — ✓ QL
Elite Bronze Tier 2 - Generic — — ✓ QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Complete Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Silver + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Signature Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options Tier 2 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty — — ✓ QL
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty — — ✓ QL
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty — — ✓ QL
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty — — ✓ QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty — — ✓ QL
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 5 - Specialty — — ✓ QL
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty — — ✓ QL
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty — — ✓ QL
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty — — ✓ QL
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Senior Care (HMO I-SNP) Tier 2 - Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic — — — None
Liberty Medicare Advantage (HMO C-SNP) Tier 2 - Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic — — — None
Troy Medicare (HMO) Tier 2 - Generic — — — None
Erickson Advantage Champion (HMO-POS C-SNP) Tier 5 - Specialty — — — None
Erickson Advantage Freedom (HMO-POS) Tier 5 - Specialty — — — None
Erickson Advantage Liberty (HMO-POS) Tier 5 - Specialty — — — None
Alignment Health AVA (PPO) Tier 5 - Specialty — — — None
HealthSpring True Choice (PPO) Tier 5 - Specialty — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 5 - Specialty — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 5 - Specialty — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 5 - Specialty — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 5 - Specialty — — — None
Alignment Health Platinum (HMO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 5 - Specialty — — — None
HealthSpring Preferred Select (HMO) Tier 5 - Specialty — — — None
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 5 - Specialty — — — None
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 5 - Specialty — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 5 - Specialty — — — None
Aetna Medicare Signature (HMO) Tier 5 - Specialty — — — None
Aetna Medicare Dual (HMO D-SNP) Tier 5 - Specialty — — — None
Aetna Medicare Signature (HMO) Tier 5 - Specialty — — — None
Aetna Medicare Value Plus (HMO) Tier 5 - Specialty — — — None
Aetna Medicare Prime (HMO) Tier 5 - Specialty — — — None
Aetna Medicare Signature Care (HMO) Tier 5 - Specialty — — — None
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 5 - Specialty — — — None
Aetna Medicare Chronic Care (HMO C-SNP) Tier 5 - Specialty — — — None
Aetna Medicare Enhanced (HMO) Tier 5 - Specialty — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 5 - Specialty — — — None
Blue Medicare PPO Enhanced (PPO) Tier 5 - Specialty — — — None
Blue Medicare Essential Plus (HMO-POS) Tier 5 - Specialty — — — None
Blue Medicare Enhanced (HMO-POS) Tier 5 - Specialty — — — None
Blue Medicare Choice (HMO) Tier 5 - Specialty — — — None
Blue Medicare Essential (HMO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 5 - Specialty — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 5 - Specialty — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 5 - Specialty — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 5 - Specialty — — — None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 5 - Specialty — — — None
Alignment Health smartHMO (HMO) Tier 5 - Specialty — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 5 - Specialty — — — None
Alignment Health Platinum Select (HMO) Tier 5 - Specialty — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 5 - Specialty — — — None
DEVOTED CORE 001 NC (HMO) Tier 5 - Specialty — — — None
DEVOTED GIVEBACK 002 NC (HMO) Tier 5 - Specialty — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 5 - Specialty — — — None
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 5 - Specialty — — — None
DEVOTED GIVEBACK 012 NC (HMO) Tier 5 - Specialty — — — None
Aetna Medicare Signature (PPO) Tier 5 - Specialty — — — None
Aetna Medicare Enhanced (PPO) Tier 5 - Specialty — — — None
Aetna Medicare Enhanced (PPO) Tier 5 - Specialty — — — None
Aetna Medicare Signature Extra (PPO) Tier 5 - Specialty — — — None
Aetna Medicare Signature (PPO) Tier 5 - Specialty — — — None
Aetna Medicare Signature (PPO) Tier 5 - Specialty — — — None
Aetna Medicare Signature Giveback (PPO) Tier 5 - Specialty — — — None
Aetna Medicare Signature (PPO) Tier 5 - Specialty — — — None
Erickson Advantage Signature (HMO-POS) Tier 5 - Specialty — — — None
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 5 - Specialty — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 5 - Specialty — — — None
HealthSpring Preferred (HMO) Tier 5 - Specialty — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 5 - Specialty — — — None
HealthSpring Preferred Savings (HMO) Tier 5 - Specialty — — — None
HealthSpring Preferred Plus (HMO) Tier 5 - Specialty — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 5 - Specialty — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 5 - Specialty — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 5 - Specialty — — — None
Experience Health Medicare Advantage (HMO) Tier 5 - Specialty — — — None
Source: CMS QHP JSON  ·  Checked: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Gold Classic Standard Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus Tier 2 - Generic — — — None
Gold Elite Saver Plus Tier 2 - Generic — — — None
Silver Simple PCP Saver Tier 2 - Generic — — — None
Bronze Classic 4700 Tier 2 - Generic — — — None
Secure Tier 2 - Generic — — — None
Secure | with Atrium Health Tier 2 - Generic — — — None
Silver Classic Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 2 - Generic — — — None
Silver Classic | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health Tier 2 - Generic — — — None
Silver Classic Standard Tier 2 - Generic — — — None
Gold Elite Saver Plus | with Atrium Health Tier 2 - Generic — — — None
Bronze Classic Standard Tier 2 - Generic — — — None
Silver Simple Diabetes Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 2 - Generic — — — None
AIAN Cost Share Tier 2 - Generic — — — None
AIAN Cost Share | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 22 hours, 41 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 4 - Non-Preferred — — — None
Something not right?