Zeposia 7-Day Starter Pac

Generic: ozanimod

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ ANOREXIANTS

Coverage by Insurer

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

AmeriHealth Caritas NC

20 plans

Source: CMS QHP JSON · Checked: 15 hours, 17 minutes ago

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

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 15 hours, 17 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026 via Zeposia	Tier 2 - Preferred Brand	✓	—	—	PA
BCBS Federal Basic Option 2026 via Zeposia	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026 via Zeposia	Tier 4 - Preferred Specialty	✓	—	—	PA

Blue Cross Blue Shield of NC

15 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 15 hours, 17 minutes ago

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

Cigna

40 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 15 hours, 17 minutes ago

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

Medicare Part D

8 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 15 hours, 17 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Longevity Health Plan (HMO I-SNP) via Zeposia	Tier 1 - Preferred Generic	✓	—	✓ 30 per 30 days	PA \| QL
Longevity Health Plan (HMO I-SNP) via Zeposia Starter	Tier 1 - Preferred Generic	✓	—	✓ 28 per 180 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP) via Zeposia	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP) via Zeposia Starter	Tier 5 - Specialty	✓	—	✓ 28 per 180 days	PA \| QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via Zeposia Starter	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare (HMO) via Zeposia Starter	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via Zeposia	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare (HMO) via Zeposia	Tier 5 - Specialty	✓	—	—	PA

NC State Health Plan

3 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 15 hours, 17 minutes ago

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

Oscar Health

28 plans

Source: CMS QHP JSON · Checked: 15 hours, 17 minutes ago

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