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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: 1 hour, 37 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Everyday Bronze Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Elite Bronze Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Expanded Bronze Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Silver Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Gold Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Gold + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Silver + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Expanded Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Gold with Atrium Health Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Silver with Atrium Health Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Complete Gold with Atrium Health Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Focused Silver with Atrium Health Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Elite Bronze with Atrium Health Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Complete Gold Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Aug 7, 2026  ·  Checked: 1 hour, 36 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026
via Nucynta 		Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Standard Option 2026
via Nucynta 		Tier 2 - Preferred Brand ✓ — — PA
Source: PDF  ·  Formulary date: Sep 4, 2026  ·  Checked: 1 hour, 36 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 7000 HSA Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 6500 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 5500 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 4400 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 3500 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 3000 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Gold CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect myDiabetesCare Bronze
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect myDiabetesCare Silver
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Gold 1500 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD 5000 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD 6000 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 3500 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 5000 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 2200 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Gold RD CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Aug 19, 2026  ·  Checked: 1 hour, 36 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Alignment Health Platinum (HMO)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health NC Duals (HMO-POS D-SNP)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health smartHMO (HMO)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum Select (HMO)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health AVA (PPO)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 1 hour, 36 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Nucynta 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Nucynta 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Nucynta 		Not Covered — — — None
Source: PDF  ·  Formulary date: Aug 25, 2026  ·  Checked: 1 hour, 36 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
54332NC0030042
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard+ Dental + Vision (No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
54332NC0060010
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard (No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Standard (No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Standard (No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
54332NC0060009
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
54332NC0060008
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
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