verapamil hcl

120 mg, 180 mg, 240 mg — Capsule

ANTIANGINAL AGENTS

Also known as: verapamil hcl er oral capsule verapamil hcl oral verapamil hcl soln 2.5mg/ml verapamil hcl cap er 24hr 120 mg, 180 mg, 240 mg verapamil hcl tab er 120 mg, 180 mg, 240 mg verapamil hcl tab 40 mg, 80 mg, 120 mg VERAPAMIL ER Verapamil HCl ER Oral Capsule Extended Release Verapamil HCl ER Oral Tablet Extended Release Verapamil HCl Oral Tablet
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Checked: 11 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 11 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026 Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Verelan 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Value 2026
via Verelan 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Care 2026
via Verelan 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Advantage 2026
via Verelan 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Verelan 		Tier 2 - Medium Cost Generic/Brand — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 11 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Gold CMS Standard
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Silver RD CMS Standard
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Silver CMS Standard
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Silver 4400 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Silver 3000 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Gold RD CMS Standard
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Bronze CMS Standard
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect myDiabetesCare Silver
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Gold 1500 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect myDiabetesCare Bronze
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Bronze 5500 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Bronze 6500 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Connect Silver 3500 Indiv Med Deductible
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 11 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via VERAPAMIL ER 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP)
via VERAPAMIL ER 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via VERAPAMIL ER 		Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP)
via VERAPAMIL ER 		Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP)
via VERAPAMIL ER 		Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP)
via VERAPAMIL ER 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP)
via VERAPAMIL ER 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via VERAPAMIL ER 		Tier 1 - Preferred Generic — — — None
Aetna Medicare Enhanced (PPO) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature Extra (PPO) Tier 2 - Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic — — — None
Troy Medicare (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Troy Medicare (HMO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature Giveback (PPO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Aetna Medicare Chronic Care (HMO C-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Chronic Care (HMO C-SNP) Tier 2 - Generic — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 2 - Generic — — — None
HealthSpring True Choice (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
HealthSpring TotalCare (HMO D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Dual (HMO D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
HealthSpring Preferred (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
HealthSpring Preferred Select (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
HealthSpring Preferred Savings (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
HealthSpring Preferred Plus (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Value Plus (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Prime (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Full Dual Care (HMO D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature Extra (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature Care (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature Giveback (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO) Tier 2 - Generic — — — None
Aetna Medicare Dual (HMO D-SNP) Tier 2 - Generic — — — None
Senior Care (HMO I-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO) Tier 2 - Generic — — — None
Aetna Medicare Value Plus (HMO) Tier 2 - Generic — — — None
Aetna Medicare Prime (HMO) Tier 2 - Generic — — — None
Aetna Medicare Signature Care (HMO) Tier 2 - Generic — — — None
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 2 - Generic — — — None
Aetna Medicare Enhanced (HMO) Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO) Tier 2 - Generic — — — None
Liberty Medicare Advantage (HMO C-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Wellcare Simple Open (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Wellcare Simple (HMO-POS)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Wellcare Simple Open (PPO) Tier 2 - Generic — — — None
Wellcare Simple (HMO-POS) Tier 2 - Generic — — — None
Wellcare Giveback Open (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Wellcare Giveback Open (PPO) Tier 2 - Generic — — — None
Blue Medicare PPO Enhanced (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Blue Medicare Essential Plus (HMO-POS)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Blue Medicare Enhanced (HMO-POS)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Blue Medicare Choice (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Blue Medicare Essential (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Experience Health Medicare Advantage (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Healthy Blue + Medicare (HMO-POS D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Wellcare Dual Reserve (HMO-POS D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Wellcare Dual Liberty (HMO-POS D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Wellcare Dual Access (HMO-POS D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Wellcare Assist Open (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Wellcare Dual Liberty Open (PPO D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Alignment Health Platinum (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Alignment Health NC Duals (HMO-POS D-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Alignment Health smartHMO (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Alignment Health Platinum Select (HMO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Alignment Health AVA (PPO)
via VERAPAMIL ER 		Tier 2 - Generic — — — None
Alignment Health Platinum (HMO) Tier 2 - Generic — — — None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 2 - Generic — — — None
Alignment Health smartHMO (HMO) Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 2 - Generic — — — None
Alignment Health Platinum Select (HMO) Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 2 - Generic — — — None
Alignment Health AVA (PPO) Tier 2 - Generic — — — None
DEVOTED CHOICE 008 NC (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S001 (PPO D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S2 (PPO D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Signature (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Guardian (HMO-POS I-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Freedom (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Liberty (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 3 - Preferred Brand — — — None
Erickson Advantage Signature (HMO-POS) Tier 3 - Preferred Brand — — — None
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 3 - Preferred Brand — — — None
Erickson Advantage Freedom (HMO-POS) Tier 3 - Preferred Brand — — — None
Erickson Advantage Liberty (HMO-POS) Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Champion (HMO-POS C-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — — None
Erickson Advantage Champion (HMO-POS C-SNP) Tier 3 - Preferred Brand — — — None
HealthSpring True Choice (PPO) Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Select (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Savings (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Plus (HMO) Tier 3 - Preferred Brand — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED CORE 001 NC (HMO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 002 NC (HMO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 012 NC (HMO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 001 NC (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 003 NC (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 005 NC (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Plan I (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Plan II (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Vitality Plan (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-070 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H5525-072 (PPO D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-083 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-025 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-026 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-057 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-060 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-061 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Choice H8145-004 (PFFS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-137 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-233 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Dual Select H1036-307 (HMO D-SNP) Tier 3 - Preferred Brand — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-335 (HMO-POS) Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5216-017 (PPO) Tier 3 - Preferred Brand — — — None
HumanaChoice H5216-211 (PPO) Tier 3 - Preferred Brand — — — None
Humana Full Access H5525-034 (PPO) Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5525-035 (PPO) Tier 3 - Preferred Brand — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-049 (PPO) Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-050 (PPO) Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-070 (PPO) Tier 3 - Preferred Brand — — — None
Humana Dual Select H5525-072 (PPO D-SNP) Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-083 (PPO) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-025 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-026 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-057 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-060 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H6622-061 (HMO-POS) Tier 3 - Preferred Brand — — — None
Humana Gold Choice H8145-004 (PFFS) Tier 3 - Preferred Brand — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-137 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-233 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Dual Select H1036-307 (HMO D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Gold Plus H1036-335 (HMO-POS)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5216-017 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5216-211 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
Humana Full Access H5525-034 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HumanaChoice Giveback H5525-035 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-049 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
HumanaChoice H5525-050 (PPO)
via VERAPAMIL ER 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 4 - Non-Preferred — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Experience Health Medicare Advantage (HMO) Tier 4 - Non-Preferred — — — None
Blue Medicare Essential (HMO) Tier 4 - Non-Preferred — — — None
Blue Medicare Choice (HMO) Tier 4 - Non-Preferred — — — None
Blue Medicare Enhanced (HMO-POS) Tier 4 - Non-Preferred — — — None
Blue Medicare Essential Plus (HMO-POS) Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 4 - Non-Preferred — — — None
Wellcare Assist Open (PPO) Tier 4 - Non-Preferred — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 001 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
Blue Medicare PPO Enhanced (PPO) Tier 4 - Non-Preferred — — — None
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 008 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED GIVEBACK 012 NC (HMO) Tier 4 - Non-Preferred — — — None
DEVOTED GIVEBACK 002 NC (HMO) Tier 4 - Non-Preferred — — — None
DEVOTED CORE 001 NC (HMO) Tier 4 - Non-Preferred — — — None
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 005 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 003 NC (PPO) Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via VERAPAMIL ER 		Tier 6 - Specialty Plus — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 11 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic — — — None
Source: Excel (XLSX)  ·  Formulary date: Jun 24, 2026  ·  Checked: 11 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Basic Core Formulary — — — None
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