thyroid (USP)

120 MG — Tablet

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

Ambetter (Centene)

170 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 20 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Clear Silver with $0 Insulin Options via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Expanded Bronze via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Silver via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Gold via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze with Atrium Health via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze with Atrium Health via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Focused Silver with Atrium Health via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold with Atrium Health via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Expanded Bronze with Atrium Health via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Silver with Atrium Health via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Gold with Atrium Health via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Expanded Bronze + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Silver + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Gold + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Silver with Atrium Health + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Signature Gold with Atrium Health + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold with Atrium Health via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze with Atrium Health via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver with Atrium Health via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold with Atrium Health via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Streamlined Silver with Atrium Health via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Streamlined Silver via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold with Atrium Health via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver with Atrium Health via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze with Atrium Health via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze with Atrium Health via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver with Atrium Health via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold with Atrium Health via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Streamlined Silver with Atrium Health via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Streamlined Silver via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Streamlined Silver with Atrium Health via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Streamlined Silver via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental via NP Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Enhanced Asthma/COPD Care Silver $0 Rx Options via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Streamlined Silver via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Streamlined Silver with Atrium Health via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options via Amerithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Streamlined Silver with Atrium Health via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Streamlined Silver via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Clear Silver with $0 Insulin Options + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via Adthyza	Tier 3 - Preferred Brand	—	—	—	None
Focused Silver with Atrium Health via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze with Atrium Health via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver with Atrium Health via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold with Atrium Health via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental via Armour Thyroid	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health via Evexithroid	Tier 3 - Preferred Brand	—	—	✓	QL

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 20 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026 via Armour Thyroid	Tier 2 - Preferred Brand	—	—	—	None
BCBS Federal Standard Option 2026 via Armour Thyroid	Tier 3 - Non-Preferred Brand	—	—	—	None
BCBS Federal Basic Option 2026 via Armour Thyroid	Tier 3 - Non-Preferred Brand	—	—	—	None

Blue Cross Blue Shield of NC

20 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 20 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Care 2026 via Evexithroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Amerithroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Local 2026 via Evexithroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Value 2026 via Evexithroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Evexithroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Local 2026 via Amerithroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Advantage 2026 via Niva Thyroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Niva Thyroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Local 2026 via Niva Thyroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Care 2026 via Niva Thyroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Advantage 2026 via Armour Thyroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Armour Thyroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Local 2026 via Armour Thyroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Care 2026 via Armour Thyroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Value 2026 via Armour Thyroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Care 2026 via Amerithroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Value 2026 via Niva Thyroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Value 2026 via Amerithroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Advantage 2026 via Evexithroid	Tier 3 - High Cost Brand	—	—	—	None
BCBSNC Blue Advantage 2026 via Amerithroid	Tier 3 - High Cost Brand	—	—	—	None

Cigna

60 plans

Source: PDF · Formulary date: Oct 15, 2026 · Checked: 20 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect myDiabetesCare Bronze via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver 5000 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver 3600 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard via NP Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver 5000 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver 3600 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD CMS Standard via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold RD CMS Standard via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 5000 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 3600 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze CMS Standard via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver CMS Standard via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold CMS Standard via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect myDiabetesCare Bronze via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect myDiabetesCare Silver via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold 1500 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD CMS Standard via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via Armour Thyroid	Tier 3 - Preferred Brand	—	—	—	None

NC State Health Plan

12 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 20 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Armour Thyroid	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Armour Thyroid	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Armour Thyroid	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Adthyza	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Amerithroid	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Adthyza	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Amerithroid	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Evexithroid	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Evexithroid	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Evexithroid	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Adthyza	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Amerithroid	Not Covered	—	—	—	None

Oscar Health

270 plans

Source: CMS QHP JSON · Formulary date: Oct 13, 2026 · Checked: 20 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
69803NC0010074	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic via NP Thyroid	Tier 2 - Generic	—	—	—	None
Secure via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic Standard via NP Thyroid	Tier 2 - Generic	—	—	—	None
Gold Classic Standard via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic Standard \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Gold Classic Standard \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Secure \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010074 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010075 via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010076 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010077 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010078 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010079 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010080 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010081 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010082 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010083 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010084 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010085 via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Core Plan via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Core Plan \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes with Adult Dental & Vision via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010108 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010109 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010110 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010111 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010112 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010113 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010114 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010115 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010116 via NP Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010117 via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes with Adult Dental & Vision \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes with Adult Dental & Vision \| with Atrium Health via NP Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Secure via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic Standard via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Gold Classic Standard via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic Standard \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Gold Classic Standard \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Secure \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010074 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010075 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010076 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010077 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010078 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010079 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010080 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010081 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010082 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010083 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010084 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010085 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Core Plan via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Core Plan \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes with Adult Dental & Vision via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010108 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010109 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010110 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010111 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010112 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010113 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010114 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010115 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010116 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010117 via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes with Adult Dental & Vision \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes with Adult Dental & Vision \| with Atrium Health via Armour Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Classic via Adthyza	Tier 2 - Generic	—	—	—	None
Secure via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Classic Standard via Adthyza	Tier 2 - Generic	—	—	—	None
Gold Classic Standard via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Classic Standard \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Gold Classic Standard \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Secure \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Classic \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010074 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010075 via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010076 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010077 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010078 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010079 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010080 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010081 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010082 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010083 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010084 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010085 via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Core Plan via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Core Plan \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes with Adult Dental & Vision via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010108 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010109 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010110 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010111 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010112 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010113 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010114 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010115 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010116 via Adthyza	Tier 2 - Generic	—	—	—	None
69803NC0010117 via Adthyza	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes with Adult Dental & Vision \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes with Adult Dental & Vision \| with Atrium Health via Adthyza	Tier 2 - Generic	—	—	—	None
Silver Core Plan via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Core Plan \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes with Adult Dental & Vision via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010108 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010109 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010110 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010111 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010112 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010113 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010114 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010115 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010116 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010117 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes with Adult Dental & Vision \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes with Adult Dental & Vision \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus	Tier 2 - Generic	—	—	—	None
Silver Classic	Tier 2 - Generic	—	—	—	None
Secure	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard	Tier 2 - Generic	—	—	—	None
Silver Classic Standard	Tier 2 - Generic	—	—	—	None
Gold Classic Standard	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Gold Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Secure \| with Atrium Health	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
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
69803NC0010075	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision \| with Atrium Health	Tier 2 - Generic	—	—	—	None
69803NC0010076	Tier 2 - Generic	—	—	—	None
69803NC0010077	Tier 2 - Generic	—	—	—	None
69803NC0010078	Tier 2 - Generic	—	—	—	None
69803NC0010079	Tier 2 - Generic	—	—	—	None
69803NC0010080	Tier 2 - Generic	—	—	—	None
69803NC0010081	Tier 2 - Generic	—	—	—	None
69803NC0010082	Tier 2 - Generic	—	—	—	None
69803NC0010083	Tier 2 - Generic	—	—	—	None
69803NC0010084	Tier 2 - Generic	—	—	—	None
69803NC0010085	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes	Tier 2 - Generic	—	—	—	None
Silver Core Plan	Tier 2 - Generic	—	—	—	None
Silver Core Plan \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes with Adult Dental & Vision	Tier 2 - Generic	—	—	—	None
69803NC0010108	Tier 2 - Generic	—	—	—	None
69803NC0010109	Tier 2 - Generic	—	—	—	None
69803NC0010110	Tier 2 - Generic	—	—	—	None
69803NC0010111	Tier 2 - Generic	—	—	—	None
69803NC0010112	Tier 2 - Generic	—	—	—	None
69803NC0010113	Tier 2 - Generic	—	—	—	None
69803NC0010114	Tier 2 - Generic	—	—	—	None
69803NC0010115	Tier 2 - Generic	—	—	—	None
69803NC0010116	Tier 2 - Generic	—	—	—	None
69803NC0010117	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes with Adult Dental & Vision \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes with Adult Dental & Vision \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Secure via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic Standard via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Gold Classic Standard via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic Standard \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Gold Classic Standard \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Secure \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Classic \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010074 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010075 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision \| with Atrium Health via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010076 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010077 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010078 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010079 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010080 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010081 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010082 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010083 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010084 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
69803NC0010085 via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision via Niva Thyroid	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes via Niva Thyroid	Tier 2 - Generic	—	—	—	None

UnitedHealthcare

68 plans

Source: PDF · Formulary date: Sep 23, 2026 · Checked: 20 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via Niva Thyroid	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 Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, 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 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 Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) via Niva Thyroid	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) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) via Armour Thyroid	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) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) via Niva Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) via Armour Thyroid	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 Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) via Armour Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) via NP Thyroid	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) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via NP Thyroid	Tier 4 - Non-Preferred	—	—	—	None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) via NP Thyroid	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 Standard ($5 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
UHC Silver Standard ($8 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 Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)	Tier 4 - Non-Preferred	—	—	—	None