Xeljanz

Generic: tofacitinib

11 MG — Tablet

Also known as: XELJANZ SOLN 1MG/ML; TABS 5MG, 10MG tofacitinib Xeljanz 1 Mg/Ml Oral Solution Xeljanz 5 Mg Tablet Xeljanz 10 Mg Tablet XELJANZ SOLN 1MG/ML; TABS 10MG XELJANZ TABS 5MG Xeljanz Oral Tablet Xeljanz Oral Solution

Compare Prices

Coverage by Insurer

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

Ambetter (Centene)

58 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 15 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental via tofacitinib	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 5 - Specialty	✓	—	✓	PA \| QL

AmeriHealth Caritas NC

10 plans

Source: CMS QHP JSON · Checked: 15 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Gold Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Essential + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Essential + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA

Blue Cross Blue Shield Federal

2 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 15 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 15 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Local 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Value 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Advantage 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Care 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL

Cigna

20 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 15 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect myDiabetesCare Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect myDiabetesCare Silver	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 2200 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold 1500 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 5500 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD 6000 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 3500 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD 5000 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 3500 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 4400 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 5000 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 3000 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 6500 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold RD CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL

Medicare Part D

72 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 15 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Longevity Health Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 480 per 24 days	PA \| QL
Provider Partners North Carolina Community Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 300 per 30 days	PA \| QL
Provider Partners North Carolina Essential Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 300 per 30 days	PA \| QL
NHC Advantage (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 300 per 30 days	PA \| QL
PruittHealth Premier (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 300 per 30 days	PA \| QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 300 per 30 days	PA \| QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 300 per 30 days	PA \| QL
Liberty Medicare Dual Plan (HMO D-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 300 per 30 days	PA \| QL
Aetna Medicare Value Plus (HMO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Prime (HMO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Signature Care (HMO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Full Dual Care (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Enhanced (HMO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Enhanced (PPO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Enhanced (PPO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Signature Extra (PPO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Signature Giveback (PPO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
Aetna Medicare Chronic Care (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Chronic Care Value (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
DEVOTED DUAL 009 NC (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
DEVOTED CORE 001 NC (HMO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
DEVOTED GIVEBACK 002 NC (HMO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
DEVOTED GIVEBACK 012 NC (HMO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
Liberty Medicare Advantage (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
HealthTeam Advantage Plan I (PPO)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
HealthTeam Advantage Plan II (PPO)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
HealthTeam Advantage Vitality Plan (PPO)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
Troy Medicare (HMO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
UHC Complete Care NC-25 (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
UHC Complete Care NC-27 (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
UHC Complete Care NC-28 (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
Erickson Advantage Champion (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
Aetna Medicare Signature (HMO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Dual (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Aetna Medicare Signature (HMO)	Tier 5 - Specialty	✓	—	✓ 480 per 24 days	PA \| QL
Senior Care (HMO I-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0019 (PPO)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0017 (PPO)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0016 (PPO)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0004 (PPO)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0001 (PPO)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
UHC Dual Complete NC-S2 (PPO D-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
UHC Dual Complete NC-S001 (PPO D-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
Erickson Advantage Liberty (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
Erickson Advantage Freedom (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
Erickson Advantage Guardian (HMO-POS I-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
Erickson Advantage Signature (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 300 per 30 days	PA \| QL

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 15 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Preferred	✓	✓	—	PA \| ST

NC State Health Plan

3 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 15 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓ Preferred for	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓ Preferred for	PA \| QL
NC State Health Plan - HDHP 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓ Preferred for	PA \| QL

Oscar Health

28 plans

Source: CMS QHP JSON · Checked: 15 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Silver Simple Chronic Care CKM \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
AIAN Cost Share	Tier 5 - Specialty	✓	—	✓	PA \| QL
AIAN Cost Share \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Diabetes \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic	Tier 5 - Specialty	✓	—	✓	PA \| QL
Secure	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic 4700	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple PCP Saver	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Elite Saver Plus	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Diabetes	Tier 5 - Specialty	✓	—	✓	PA \| QL
Secure \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic 4700 \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Diabetes \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple PCP Saver \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Elite Saver Plus \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Classic Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic Standard \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic Standard \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Classic Standard \| with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus	Tier 5 - Specialty	✓	—	✓	PA \| QL

UnitedHealthcare

13 plans

Source: PDF · Formulary date: Jun 23, 2026 · Checked: 15 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Standard+ Dental + Vision (No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Standard (No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Standard (No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Standard (No Referrals)	Tier 5 - Specialty	✓	—	✓	PA \| QL