Xyzal
Generic: levocetirizine dihydrochloride
0.5 MG — Solution
Histamine-1 Receptor Antagonist
Also known as:
levocetirizine dihydrochloride
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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)
58 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Complete Gold with Atrium Health + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Elite Bronze
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Clear Silver with $0 Insulin Options
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Expanded Bronze
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Silver
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Gold
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Focused Silver with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Complete Gold with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Expanded Bronze with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Silver with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Gold with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Complete Gold + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Everyday Bronze + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Elite Bronze + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Everyday Bronze
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Expanded Bronze + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Silver + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | ✓ | QL |
|
Complete Gold
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Gold + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | ✓ | QL |
| Complete Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Elite Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Silver | Tier 2 - Generic | — | — | ✓ | QL |
| Standard Gold | Tier 2 - Generic | — | — | ✓ | QL |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
Medicare Part D
56 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Longevity Health Plan (HMO I-SNP)
via levocetirizine dihydrochloride |
Tier 1 - Preferred Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
Aetna Medicare Signature (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring True Choice (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring Preferred (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED CORE 001 NC (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED GIVEBACK 002 NC (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED GIVEBACK 012 NC (HMO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED CHOICE 001 NC (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED CHOICE 003 NC (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED CHOICE 005 NC (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via levocetirizine dihydrochloride |
Tier 4 - Non-Preferred | — | — | ✓ 300 per 30 days | QL |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Silver Simple Diabetes | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Gold Elite Saver Plus | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Gold Classic Standard | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic Standard | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic Standard | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Gold Classic Standard
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic Standard
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic Standard
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple PCP Saver | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Secure
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Diabetes | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Chronic Care CKM | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AIAN Cost Share
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
AIAN Cost Share | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic 4700
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple PCP Saver
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Gold Elite Saver Plus
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Diabetes
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Secure | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic 4700 | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic | with Atrium Health
via levocetirizine dihydrochloride |
Tier 2 - Generic | — | — | — | None |
TRICARE
1 planUnitedHealthcare
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 levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Bronze Standard (No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Gold Standard (No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Silver Standard (No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via levocetirizine dihydrochloride |
Tier 3 - Preferred Brand | — | — | — | None |