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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 |
|---|---|---|---|---|---|
| Elite Bronze | Tier 2 - Generic | ✓ | — | — | PA |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Expanded Bronze | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Gold with Atrium Health | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Silver with Atrium Health | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | ✓ | — | — | PA |
| Complete Gold with Atrium Health | Tier 2 - Generic | ✓ | — | — | PA |
| Focused Silver with Atrium Health | Tier 2 - Generic | ✓ | — | — | PA |
| Elite Bronze with Atrium Health | Tier 2 - Generic | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Gold | Tier 2 - Generic | ✓ | — | — | PA |
| Standard Silver | Tier 2 - Generic | ✓ | — | — | PA |
| Complete Gold | Tier 2 - Generic | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | ✓ | — | — | PA |
| Everyday Bronze | Tier 2 - Generic | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Natroba |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Natroba |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Blue Cross Blue Shield of NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Advantage 2026
via Natroba |
Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
| BCBSNC Blue Local 2026 | Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
| BCBSNC Blue Advantage 2026 | Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
|
BCBSNC Blue Value 2026
via Natroba |
Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
|
BCBSNC Blue Care 2026
via Natroba |
Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
|
BCBSNC Blue Local 2026
via Natroba |
Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Natroba |
Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
| BCBSNC Blue Value 2026 | Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
| BCBSNC Blue Care 2026 | Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
NC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Natroba |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Natroba |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Natroba |
Tier 3 - Non-Preferred Brand | — | — | — | None |