topiramate
Generic: Eprontia
25 mg, 50 mg, 100 mg, 150 mg, 200 mg — Tablet
Also known as:
topiramate oral capsule sprinkle
topiramate oral tablet
topiramate cap er 24hr sprinkle 25 mg, 50 mg, 100 mg, 150 mg, 200 mg
topiramate tab 25 mg, 50 mg, 100 mg, 200 mg
Topiramate 15 Mg Sprinkle Capsule
Topiramate 25 Mg Sprinkle Capsule
Topiramate 25 Mg Tablet
Topiramate 50 Mg Tablet
Topiramate 100 Mg Tablet
Topiramate 200 Mg Tablet
Topiramate Er 25 Mg Sprinkle Capsule
Topiramate Er 50 Mg Sprinkle Capsule
Topiramate Er 100 Mg Sprinkle Capsule
Topiramate Er 150 Mg Sprinkle Capsule
Topiramate Er 200 Mg Sprinkle Capsule
Topiramate Oral Tablet
Topiramate Oral Capsule Sprinkle
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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 |
|---|---|---|---|---|---|
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
4 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Topamax |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Topamax |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Eprontia |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Eprontia |
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 Local 2026
via Topamax |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Topamax |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Topamax |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Value 2026
via Topamax |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Care 2026
via Topamax |
Tier 1 - Lowest Cost Generic | — | — | — | None |
| BCBSNC Blue Local 2026 | Tier 2 - Medium Cost Generic/Brand | ✓ | — | ✓ | PA | QL |
| BCBSNC Blue Value 2026 | Tier 2 - Medium Cost Generic/Brand | ✓ | — | ✓ | PA | QL |
| BCBSNC Blue Advantage 2026 | Tier 2 - Medium Cost Generic/Brand | ✓ | — | ✓ | PA | QL |
| BCBSNC Blue Care 2026 | Tier 2 - Medium Cost Generic/Brand | ✓ | — | ✓ | PA | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 2 - Medium Cost Generic/Brand | ✓ | — | ✓ | PA | QL |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 6500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 5500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver 4400 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver 3500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver 3000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Gold CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect myDiabetesCare Bronze | Tier 2 - Generic | — | — | — | None |
| Connect myDiabetesCare Silver | Tier 2 - Generic | — | — | — | None |
| Connect Gold 1500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Bronze RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
| Connect Gold RD CMS Standard | Tier 2 - Generic | — | — | — | None |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 2 - Generic | — | — | — | None |
Medicare Part D
229 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Eprontia |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Eprontia |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Eprontia |
Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| HealthTeam Advantage Plan II (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| HealthTeam Advantage Plan I (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Troy Medicare (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Senior Care (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health Platinum (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health smartHMO (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health Platinum Select (HMO) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Wellcare Simple (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Advantage (HMO C-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 |
| Erickson Advantage Liberty (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| Erickson Advantage Freedom (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Erickson Advantage Signature (HMO-POS) | Tier 1 - Preferred Generic | — | — | — | None |
| Wellcare Giveback Open (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 1 - Preferred Generic | — | — | — | None |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H1036-137 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Assist Open (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Dual (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Value Plus (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Prime (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature Care (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Enhanced (HMO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Blue Medicare PPO Enhanced (PPO) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare Essential Plus (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare Enhanced (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare Choice (HMO) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare Essential (HMO) | Tier 2 - Generic | — | — | — | None |
| Experience Health Medicare Advantage (HMO) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5216-211 (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CORE 001 NC (HMO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature Extra (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature Giveback (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | ✓ 60 per 30 days | QL |
| Humana Full Access H5525-034 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-049 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-050 (PPO) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-070 (PPO) | Tier 2 - Generic | — | — | — | None |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 2 - Generic | — | — | — | None |
| HumanaChoice H5525-083 (PPO) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 2 - Generic | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 2 - Generic | ✓ | — | — | PA |
| Humana Gold Choice H8145-004 (PFFS) | Tier 2 - Generic | — | — | — | None |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE 001 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE 003 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE 005 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE 008 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 2 - Generic | — | — | — | None |
| HealthSpring TotalCare (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| HealthSpring Preferred (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| HealthSpring Preferred Select (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| HealthSpring Preferred Savings (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| HealthSpring Preferred Plus (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
|
HumanaChoice H5525-083 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Enhanced (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Enhanced (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Signature Extra (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Signature Giveback (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Full Access H5525-034 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
HumanaChoice Giveback H5525-035 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
HumanaChoice H5525-049 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
HumanaChoice H5525-050 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
HumanaChoice H5525-070 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Erickson Advantage Signature (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
HealthSpring True Choice (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
Humana Gold Choice H8145-004 (PFFS)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
HealthSpring TotalCare (HMO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
HealthSpring Preferred (HMO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
HealthSpring Preferred Select (HMO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
HealthSpring Preferred Savings (HMO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
HealthSpring Preferred Plus (HMO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | — | PA |
|
HealthTeam Advantage Plan I (PPO)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Dual (HMO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Signature (HMO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Value Plus (HMO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Prime (HMO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Signature Care (HMO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Enhanced (HMO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
HumanaChoice Giveback H5216-017 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
HumanaChoice H5216-211 (PPO)
via Eprontia |
Tier 4 - Non-Preferred | ✓ | — | ✓ 480 per 30 days | PA | QL |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Eprontia |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Eprontia |
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 - HDHP 2026
via Topamax |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Topamax |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Topamax |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| 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 |
| Gold Classic Standard | 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 Classic Standard | Tier 2 - Generic | — | — | — | None |
| Silver Simple Diabetes | 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 |
| Silver Classic | Tier 2 - Generic | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 2 - Generic | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | 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 |
| Silver Classic Standard | Tier 2 - Generic | — | — | — | None |
UnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| 54332NC0060009 | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Standard (No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| 54332NC0060008 | Tier 3 - Preferred Brand | — | — | — | None |
| 54332NC0030042 | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Standard (No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Standard (No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| 54332NC0060010 | Tier 3 - Preferred Brand | — | — | — | None |