Zenpep
Generic: amylase
000 Unit — Delayed Release Capsule
Also known as:
ZENPEP CAP 3000UNIT
ZENPEP CAP 5000UNIT
ZENPEP CAP 10000UNT
ZENPEP CAP 15000UNT
ZENPEP CAP 20000UNT
ZENPEP CAP 25000UNT
ZENPEP CAP 40000UNT
ZENPEP CAP 60000UNT
amylase
Zenpep Dr 3,000 Unit Capsule
Zenpep Dr 40,000 Unit Capsule
Zenpep Dr 5,000 Unit Capsule
Zenpep Dr 10,000 Unit Capsule
Zenpep Dr 15,000 Unit Capsule
Zenpep Dr 20,000 Unit Capsule
Zenpep Dr 25,000 Unit Capsule
Zenpep Dr 60,000 Unit Capsule
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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)
87 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Elite Bronze with Atrium Health
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Standard Gold | Tier 3 - Preferred Brand | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Gold with Atrium Health
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Silver with Atrium Health
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Complete Gold with Atrium Health
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
|
Focused Silver with Atrium Health
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Standard Silver | Tier 3 - Preferred Brand | — | — | — | None |
|
Everyday Bronze with Atrium Health
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Gold
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Silver
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Expanded Bronze
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Elite Bronze
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Everyday Bronze
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Complete Gold
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Standard Gold with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Standard Silver with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Complete Gold with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Focused Silver with Atrium Health | Tier 3 - Preferred Brand | — | — | — | None |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
| Standard Gold + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
| Standard Silver + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Complete Gold | Tier 3 - Preferred Brand | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 3 - Preferred Brand | — | — | — | None |
| Everyday Bronze | Tier 3 - Preferred Brand | — | — | — | None |
| Elite Bronze | Tier 3 - Preferred Brand | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 3 - Preferred Brand | — | — | — | None |
| Standard Expanded Bronze | Tier 3 - Preferred Brand | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold with Atrium Health
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver with Atrium Health
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold with Atrium Health
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Everyday Bronze with Atrium Health
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze with Atrium Health
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Focused Silver with Atrium Health
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via Pancreaze |
Tier 4 - Non-Preferred | — | — | — | None |
Blue Cross Blue Shield Federal
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Standard Option 2026
via Creon |
Tier 2 - Preferred Brand | — | — | — | None |
| BCBS Federal Standard Option 2026 | Tier 2 - Preferred Brand | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Creon |
Tier 2 - Preferred Brand | — | — | — | None |
|
BCBS Federal Focus 2026
via Creon |
Tier 2 - Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Pancreaze |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Pancreaze |
Tier 3 - Non-Preferred Brand | — | — | — | None |
Blue Cross Blue Shield of NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Care 2026 | Tier 3 - High Cost Brand | ✓ | — | — | PA |
| BCBSNC Blue Local 2026 | Tier 3 - High Cost Brand | ✓ | — | — | PA |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 3 - High Cost Brand | ✓ | — | — | PA |
| BCBSNC Blue Advantage 2026 | Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Value 2026
via Creon |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Care 2026
via Creon |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Local 2026
via Creon |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Advantage 2026
via Creon |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Creon |
Tier 3 - High Cost Brand | ✓ | — | — | PA |
| BCBSNC Blue Value 2026 | Tier 3 - High Cost Brand | ✓ | — | — | PA |
Cigna
2 plansMedicare Part D
278 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Longevity Health Plan (HMO I-SNP)
via Creon |
Tier 1 - Preferred Generic | — | — | — | None |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Creon |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Creon |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Creon |
Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Creon |
Tier 1 - Preferred Generic | — | — | — | None |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Creon |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Creon |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Creon |
Tier 1 - Preferred Generic | — | — | — | None |
| Senior Care (HMO I-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Creon |
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 Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Creon |
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 |
|
Aetna Medicare Signature (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Wellcare Giveback Open (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Blue Medicare PPO Enhanced (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Blue Medicare Essential Plus (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| Blue Medicare Enhanced (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| Blue Medicare Choice (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Blue Medicare Essential (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Experience Health Medicare Advantage (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health AVA (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Alignment Health Platinum (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Alignment Health smartHMO (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Alignment Health Platinum Select (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Plan I (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Plan II (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
Troy Medicare (HMO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Troy Medicare (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Wellcare Assist Open (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Wellcare Simple (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Creon |
Tier 3 - Preferred Brand | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 005 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 008 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED CHOICE 003 NC (PPO) | 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 |
| Aetna Medicare Prime (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Value Plus (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H1036-137 (HMO-POS) | 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 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 CHOICE GIVEBACK 004 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 |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5216-211 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Full Access H5525-034 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-049 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-050 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-070 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HumanaChoice H5525-083 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Choice H8145-004 (PFFS) | Tier 4 - Non-Preferred | — | — | — | None |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred Plus (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred Savings (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred Select (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring TotalCare (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature Giveback (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature Extra (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Enhanced (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature Care (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
NC Medicaid PDL
2 plansNC State Health Plan
9 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - HDHP 2026
via Creon |
Tier 2 - Non-Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Creon |
Tier 2 - Non-Preferred Generic | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Creon |
Tier 2 - Non-Preferred Generic | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Pancreaze |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Pancreaze |
Tier 3 - Non-Preferred Brand | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Pancreaze |
Tier 3 - Non-Preferred Brand | — | — | — | None |
UnitedHealthcare
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UnitedHealthcare NC Individual & Family 2026
via Creon |
Tier 3 - Mid-Range Cost | — | — | — | None |
| UnitedHealthcare NC Individual & Family 2026 | Tier 3 - Mid-Range Cost | — | — | — | None |