Vaxneuvance

Generic: Streptococcus pneumoniae serotype

0.002 MG — Prefilled Syringe

Also known as: Streptococcus pneumoniae serotype Vaxneuvance 0.5 Ml Syringe VAXNEUVANCE INJ Vaxneuvance Intramuscular Suspension Prefilled Syringe

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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)

87 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 17 hours, 40 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Complete Gold + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Complete Gold + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver with Atrium Health + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold with Atrium Health + Vision + Adult Dental via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Complete Gold	Tier 0 - $0 Preventive	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze	Tier 0 - $0 Preventive	—	—	✓	QL
Clear Silver with $0 Insulin Options	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze with Atrium Health	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze with Atrium Health	Tier 0 - $0 Preventive	—	—	✓	QL
Focused Silver with Atrium Health	Tier 0 - $0 Preventive	—	—	✓	QL
Complete Gold with Atrium Health	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver with Atrium Health	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold with Atrium Health	Tier 0 - $0 Preventive	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Gold via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Everyday Bronze with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Elite Bronze with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Focused Silver with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Complete Gold with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Expanded Bronze with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Silver with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Gold with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Complete Gold + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Everyday Bronze + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Elite Bronze + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Expanded Bronze + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Silver + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Gold + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Silver with Atrium Health + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Gold with Atrium Health + Vision + Adult Dental via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Complete Gold via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Complete Gold via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Everyday Bronze via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Elite Bronze via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Clear Silver with $0 Insulin Options via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Expanded Bronze via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Standard Expanded Bronze with Atrium Health	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Clear Silver with $0 Insulin Options via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Gold via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Focused Silver with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Complete Gold with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL
Standard Silver + Vision + Adult Dental	Tier 0 - $0 Preventive	—	—	✓	QL

AmeriHealth Caritas NC

37 plans

Source: CMS QHP JSON · Checked: 17 hours, 40 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Bronze Essential + No Referrals via Prevnar 20	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via Prevnar 20	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Signature + No Referrals via Prevnar 20	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals via Prevnar 20	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Gold Signature + No Referrals	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Gold Premier + No Referrals	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Signature + No Referrals	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + No Referrals	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Premier + No Referrals	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Essential + No Referrals	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + No Referrals	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Gold Premier + No Referrals via Prevnar 20	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Premier + No Referrals via Prevnar 20	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + No Referrals via Prevnar 20	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals via Prevnar 20	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Gold Signature + No Referrals via Prevnar 20	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Essential + No Referrals via Prevnar 20	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals via Prevnar 13	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Premier + No Referrals via Prevnar 13	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + No Referrals via Prevnar 13	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via Prevnar 13	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Gold Signature + No Referrals via Prevnar 13	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Signature + No Referrals via Prevnar 13	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + No Referrals via Prevnar 13	Brand-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via Capvaxive	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Gold Signature + No Referrals via Capvaxive	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals via Capvaxive	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Premier + No Referrals via Capvaxive	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Essential + No Referrals via Capvaxive	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Essential + No Referrals via Capvaxive	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Gold Premier + No Referrals via Capvaxive	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Premier + No Referrals via Capvaxive	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Signature + No Referrals via Capvaxive	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Bronze Signature + No Referrals via Capvaxive	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Brand-Preferred	—	—	—	None

Blue Cross Blue Shield of NC

15 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 17 hours, 40 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Advantage 2026 via Prevnar 20	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Care 2026	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Value 2026	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Advantage 2026 via Capvaxive	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Capvaxive	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Local 2026 via Capvaxive	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Care 2026 via Capvaxive	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Value 2026 via Capvaxive	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Prevnar 20	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Local 2026 via Prevnar 20	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Care 2026 via Prevnar 20	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Value 2026 via Prevnar 20	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Advantage 2026	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026	Tier A - ACA $0 Copay	—	—	—	None
BCBSNC Blue Local 2026	Tier A - ACA $0 Copay	—	—	—	None

Cigna

60 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 17 hours, 40 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Bronze CMS Standard via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect myDiabetesCare Silver via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold 1500 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect myDiabetesCare Bronze via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 3500 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 4400 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect myDiabetesCare Silver via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold 1500 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect myDiabetesCare Bronze via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 3500 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 4400 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect myDiabetesCare Silver	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold 1500 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect myDiabetesCare Bronze	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 3500 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 4400 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver 3000 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver CMS Standard via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD CMS Standard via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold CMS Standard via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD CMS Standard via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold RD CMS Standard via Prevnar 20	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver CMS Standard	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD CMS Standard	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold CMS Standard	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD CMS Standard	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold RD CMS Standard	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze CMS Standard	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver CMS Standard via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Silver RD CMS Standard via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold CMS Standard via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze RD CMS Standard via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Gold RD CMS Standard via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None
Connect Bronze CMS Standard via Capvaxive	Tier 3 - Preferred Brand	—	—	—	None

NC State Health Plan

6 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 17 hours, 40 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 via Prevnar 20	Tier 0 - $0 Copay (ACA Preventive)	—	—	—	None
NC State Health Plan - HDHP 2026	Tier 0 - $0 Copay (ACA Preventive)	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Tier 0 - $0 Copay (ACA Preventive)	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026	Tier 0 - $0 Copay (ACA Preventive)	—	—	—	None
NC State Health Plan - HDHP 2026 via Prevnar 20	Tier 0 - $0 Copay (ACA Preventive)	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Prevnar 20	Tier 0 - $0 Copay (ACA Preventive)	—	—	—	None

Oscar Health

112 plans

Source: CMS QHP JSON · Checked: 17 hours, 40 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Silver Simple PCP Saver \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Gold Elite Saver Plus \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Simple Chronic Care CKM \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Simple Diabetes \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Chronic Care CKM \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
AIAN Cost Share via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
AIAN Cost Share \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Classic Standard	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic Standard	Tier 0 - $0 Preventive	—	—	—	None
Gold Classic Standard	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic Standard \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic Standard \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Gold Classic Standard \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Bronze Elite + PCP Saver Plus	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic	Tier 0 - $0 Preventive	—	—	—	None
Secure	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic 4700	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple PCP Saver	Tier 0 - $0 Preventive	—	—	—	None
Gold Elite Saver Plus	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Diabetes	Tier 0 - $0 Preventive	—	—	—	None
Secure \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic 4700 \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Diabetes \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Gold Elite Saver Plus \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Diabetes via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
AIAN Cost Share	Tier 0 - $0 Preventive	—	—	—	None
AIAN Cost Share \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health	Tier 0 - $0 Preventive	—	—	—	None
Secure \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Classic 4700 \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Elite + PCP Saver Plus \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Classic \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Diabetes \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Classic Standard via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Gold Classic Standard via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic Standard \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic Standard \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Gold Classic Standard \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Bronze Elite + PCP Saver Plus via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Secure via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic 4700 via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple PCP Saver via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Gold Elite Saver Plus via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Diabetes via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Secure \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic 4700 \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Diabetes \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Gold Elite Saver Plus \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
AIAN Cost Share via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
AIAN Cost Share \| with Atrium Health via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic Standard via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Classic Standard via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Gold Classic Standard via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Classic Standard \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Classic Standard \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Gold Classic Standard \| with Atrium Health via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Elite + PCP Saver Plus via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Classic via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Secure via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Classic 4700 via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple PCP Saver via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Gold Elite Saver Plus via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Classic Standard via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic Standard via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Gold Classic Standard via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic Standard \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic Standard \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Gold Classic Standard \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Bronze Elite + PCP Saver Plus via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Secure via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic 4700 via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple PCP Saver via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Gold Elite Saver Plus via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Diabetes via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Secure \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic 4700 \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Classic \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Diabetes \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Gold Elite Saver Plus \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
AIAN Cost Share via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
AIAN Cost Share \| with Atrium Health via Capvaxive	Tier 0 - $0 Preventive	—	—	—	None
Bronze Classic Standard via Prevnar 13	Tier 0 - $0 Preventive	—	—	—	None

UnitedHealthcare

39 plans

Source: PDF · Formulary date: Jun 23, 2026 · Checked: 17 hours, 40 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Standard (No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Standard (No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Standard (No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Standard (No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Standard+ Dental + Vision (No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Standard+ Dental + Vision (No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Standard (No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Standard (No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) via Capvaxive	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Standard+ Dental + Vision (No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Standard (No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Standard (No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Bronze Standard (No Referrals) via Prevnar 20	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)	Tier 0 - $0 Preventive	—	—	✓	QL