Xeloda
Generic: capecitabine
150MG, 500MG — Tablet
Also known as:
XELODA TABS 150MG, 500MG
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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Ambetter (Centene)
29 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Elite Bronze + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold + Vision + Adult Dental
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via capecitabine |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via capecitabine |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via capecitabine |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via capecitabine |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via capecitabine |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via capecitabine |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via capecitabine |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via capecitabine |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via capecitabine |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via capecitabine |
Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via capecitabine |
Tier 2 - Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via capecitabine |
Tier 4 - Preferred Specialty | — | — | — | None |
|
BCBS Federal Basic Option 2026
via capecitabine |
Tier 4 - Preferred Specialty | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Care 2026 | Tier 2 - Medium Cost Generic/Brand | ✓ | — | — | PA |
| BCBSNC Blue Value 2026 | Tier 2 - Medium Cost Generic/Brand | ✓ | — | — | PA |
| BCBSNC Blue Advantage 2026 | Tier 2 - Medium Cost Generic/Brand | ✓ | — | — | PA |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 2 - Medium Cost Generic/Brand | ✓ | — | — | PA |
| BCBSNC Blue Local 2026 | Tier 2 - Medium Cost Generic/Brand | ✓ | — | — | PA |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Gold CMS Standard
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect myDiabetesCare Silver
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Silver RD 2200 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Gold 1500 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect myDiabetesCare Bronze
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Bronze 5500 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Bronze RD 6000 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Silver 3500 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Bronze RD 5000 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Silver RD 3500 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Silver 4400 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Silver RD 5000 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Silver 3000 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Bronze 6500 Indiv Med Deductible
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Silver CMS Standard
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Silver RD CMS Standard
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Bronze RD CMS Standard
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Gold RD CMS Standard
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
Connect Bronze CMS Standard
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via capecitabine |
Tier 4 - Specialty Generic | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - 70/30 Standard PPO 2026
via capecitabine |
Tier 4 - Specialty Generic | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - HDHP 2026
via capecitabine |
Tier 4 - Specialty Generic | ✓ | — | ✓ | PA | QL |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Simple Diabetes | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Chronic Care CKM | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AIAN Cost Share | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple PCP Saver
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Elite Saver Plus
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Simple Diabetes
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Secure | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic 4700 | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Silver Classic Standard
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Gold Classic Standard
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Bronze Classic Standard | with Atrium Health
via capecitabine |
Tier 5 - Specialty | ✓ | — | — | PA |
UnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Silver Standard (No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Bronze Standard (No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |
|
UHC Gold Standard (No Referrals)
via capecitabine |
Tier 5 - Specialty | — | — | — | None |