Abuse-Deterrent

100 MG — Extended Release Tablet

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

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 20 hours, 41 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Complete Gold	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Everyday Bronze	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Elite Bronze	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Expanded Bronze	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Silver	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Gold	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Focused Silver with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Complete Gold with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Silver with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Gold with Atrium Health	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Elite Bronze + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Expanded Bronze + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL

Blue Cross Blue Shield Federal

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 20 hours, 41 minutes ago

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

Cigna

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 20 hours, 41 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026 via Xtampza	Tier 2 - Preferred Brand	✓	—	—	PA

Medicare Part D

76 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 20 hours, 41 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Provider Partners North Carolina Advantage Plan (HMO I-SNP) via Xtampza	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Community Plan (HMO I-SNP) via Xtampza	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Essential Plan (HMO I-SNP) via Xtampza	Tier 1 - Preferred Generic	—	—	—	None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) via Xtampza	Tier 3 - Preferred Brand	—	—	—	None
HealthTeam Advantage Vitality Plan (PPO) via Xtampza	Tier 3 - Preferred Brand	—	—	—	None
HealthTeam Advantage Plan II (PPO) via Xtampza	Tier 3 - Preferred Brand	—	—	—	None
HealthTeam Advantage Plan I (PPO) via Xtampza	Tier 3 - Preferred Brand	—	—	—	None
Aetna Medicare Enhanced (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Enhanced (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Enhanced (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Signature Extra (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Signature Giveback (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Chronic Care (HMO C-SNP)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
Aetna Medicare Chronic Care Value (HMO C-SNP)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
UHC Dual Complete NC-S001 (PPO D-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
UHC Dual Complete NC-S2 (PPO D-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0001 (PPO) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0004 (PPO) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0016 (PPO) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0017 (PPO) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0019 (PPO) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
Erickson Advantage Signature (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
Erickson Advantage Guardian (HMO-POS I-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
Erickson Advantage Freedom (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
Erickson Advantage Liberty (HMO-POS) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
UHC Complete Care NC-25 (HMO-POS C-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
UHC Complete Care NC-27 (HMO-POS C-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
UHC Complete Care NC-28 (HMO-POS C-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
Erickson Advantage Champion (HMO-POS C-SNP) via Xtampza	Tier 4 - Non-Preferred	—	—	✓ 180 per 30 days	QL
Aetna Medicare Signature (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Dual (HMO D-SNP)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Signature (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Value Plus (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Prime (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Signature Care (HMO)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
Aetna Medicare Full Dual Care (HMO D-SNP)	Tier 4 - Non-Preferred	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED DUAL 009 NC (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED CORE 001 NC (HMO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED GIVEBACK 002 NC (HMO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED GIVEBACK 012 NC (HMO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED CHOICE 001 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED CHOICE 003 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED CHOICE 005 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED CHOICE 008 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 20 hours, 41 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Xtampza	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Xtampza	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Xtampza	Not Covered	—	—	—	None