Vocabria

Generic: cabotegravir

30 MG — Tablet

Human Immunodeficiency Virus Integrase Strand Transfer Inhibitor

Also known as: Vocabria Oral Tablet cabotegravir

Coverage by Insurer

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

Ambetter (Centene)

102 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 18 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Elite Bronze via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Clear Silver with $0 Insulin Options via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	—	None
Signature Gold via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Focused Silver with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	—	None
Complete Gold with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	—	None
Focused Silver with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Gold with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	—	None
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	—	None
Everyday Bronze + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Gold + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	—	None
Complete Gold via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Streamlined Silver via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Streamlined Silver with Atrium Health via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Gold + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Gold with Atrium Health via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver with Atrium Health via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze with Atrium Health via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold with Atrium Health via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Focused Silver with Atrium Health via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze with Atrium Health via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Clear Silver with $0 Insulin Options via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze with Atrium Health via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Gold via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Gold via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Streamlined Silver with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Streamlined Silver via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via CABENUVA 600 MG / 900 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Clear Silver with $0 Insulin Options via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold via Apretude	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Streamlined Silver via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Streamlined Silver with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Gold + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	—	None
Everyday Bronze + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Complete Gold + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	—	None
Signature Gold with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Signature Silver with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	—	None
Complete Gold via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	—	None
Enhanced Asthma/COPD Care Silver $0 Rx Options via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL
Everyday Bronze via CABENUVA 400 MG / 600 MG	Tier 4 - Non-Preferred	—	—	✓	QL

AmeriHealth Caritas NC

44 plans

Source: CMS QHP JSON · Formulary date: Sep 22, 2026 · Checked: 18 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via Apretude	Tier 3 - Preferred Brand	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 3 - Preferred Brand	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 600 MG / 900 MG	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 400 MG / 600 MG	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 600 MG / 900 MG	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Brand-Preferred	—	—	✓	QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via CABENUVA 400 MG / 600 MG	Brand-Preferred	—	—	✓	QL

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 18 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026 via Apretude	Tier 2 - Preferred Brand	✓	—	— NCTM for HIV PrEP	PA
BCBS Federal Standard Option 2026 via Apretude	Tier 2 - Preferred Brand	✓	—	— NCTM for HIV PrEP	PA
BCBS Federal Basic Option 2026 via Apretude	Tier 2 - Preferred Brand	✓	—	— NCTM for HIV PrEP	PA

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 18 hours, 28 minutes ago

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

NC State Health Plan

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 18 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Apretude	Tier 0 - $0 Copay (ACA Preventive)	—	—	✓	QL
NC State Health Plan - 70/30 Standard PPO 2026 via Apretude	Tier 0 - $0 Copay (ACA Preventive)	—	—	✓	QL
NC State Health Plan - 80/20 Plus PPO 2026 via Apretude	Tier 0 - $0 Copay (ACA Preventive)	—	—	✓	QL

Oscar Health

162 plans

Source: CMS QHP JSON · Formulary date: Oct 13, 2026 · Checked: 18 hours, 28 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
69803NC0010113 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010114 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010115 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010116 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010117 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Simple Diabetes with Adult Dental & Vision \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Diabetes with Adult Dental & Vision \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Core Plan \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Diabetes with Adult Dental & Vision via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010108 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Elite + PCP Saver Plus with Adult Dental & Vision \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010076 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010077 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010078 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010079 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010080 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010081 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010082 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010083 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010084 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010085 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010109 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010110 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010111 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Elite + PCP Saver Plus with Adult Dental & Vision via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Simple Diabetes via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Core Plan via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Elite + PCP Saver Plus via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Classic via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Secure via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Classic 4700 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple PCP Saver via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Diabetes via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Classic Standard via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Classic Standard via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Gold Classic Standard via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Classic Standard \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Classic Standard \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Gold Classic Standard \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Simple Chronic Care CKM \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Secure \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Classic 4700 \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Elite + PCP Saver Plus \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Classic \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Diabetes \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple PCP Saver \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Bronze Simple Diabetes \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Chronic Care CKM \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010074 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010075 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
69803NC0010112 via Apretude	Tier 0 - $0 Preventive	—	—	✓	QL
Gold Classic Standard via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic Standard via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic Standard via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Elite + PCP Saver Plus via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Diabetes via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple PCP Saver via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic 4700 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Secure via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Diabetes with Adult Dental & Vision \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Diabetes with Adult Dental & Vision \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010117 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010116 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010115 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010114 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010113 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010112 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010111 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010110 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010109 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010108 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Diabetes with Adult Dental & Vision via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Core Plan \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Core Plan via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Diabetes via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Elite + PCP Saver Plus via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Secure via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic 4700 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple PCP Saver via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Diabetes via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic Standard via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic Standard via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Gold Classic Standard via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic Standard \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic Standard \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Gold Classic Standard \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Chronic Care CKM \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Secure \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic 4700 \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Elite + PCP Saver Plus \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Diabetes \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple PCP Saver \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Diabetes \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Chronic Care CKM \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010074 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010075 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Elite + PCP Saver Plus with Adult Dental & Vision via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010085 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010084 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010083 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010082 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Elite + PCP Saver Plus with Adult Dental & Vision \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010076 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010077 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010078 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010079 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010080 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010081 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010082 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010083 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010084 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010085 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Elite + PCP Saver Plus with Adult Dental & Vision via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Diabetes via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Core Plan via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Core Plan \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Diabetes with Adult Dental & Vision via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010108 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010109 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010110 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010111 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010112 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010113 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010114 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010115 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010116 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010117 via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Diabetes with Adult Dental & Vision \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Diabetes with Adult Dental & Vision \| with Atrium Health via CABENUVA 400 MG / 600 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010081 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010080 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010079 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010078 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010077 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010076 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Elite + PCP Saver Plus with Adult Dental & Vision \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010075 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
69803NC0010074 via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Chronic Care CKM \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Diabetes \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple PCP Saver \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Simple Diabetes \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Elite + PCP Saver Plus \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic 4700 \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Secure \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Chronic Care CKM \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Gold Classic Standard \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Silver Classic Standard \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL
Bronze Classic Standard \| with Atrium Health via CABENUVA 600 MG / 900 MG	Tier 3 - Preferred Brand	—	—	✓	QL