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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.
Blue Cross Blue Shield Federal
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Betimol |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Betimol |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Medicare Part D
57 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Betimol |
Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Choice H8145-004 (PFFS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H1036-137 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5216-211 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Full Access H5525-034 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-049 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-050 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-070 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-083 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
NC Medicaid PDL
2 plansNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via Betimol |
Not Covered | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Betimol |
Not Covered | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Betimol |
Not Covered | — | — | — | None |