Aptensio XR

Generic: methylphenidate

Capsule

Antihyperkinesis / Adhd

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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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 19 hours, 7 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Silver + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Expanded Bronze + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Gold
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Silver
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Gold with Atrium Health
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Silver with Atrium Health
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold with Atrium Health
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Focused Silver with Atrium Health
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze with Atrium Health
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Expanded Bronze
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Standard Gold + Vision + Adult Dental
via methylphenidate 		Tier 2 - Generic ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 19 hours, 7 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026
via Quillichew 		Tier 3 - Non-Preferred Brand ✓ — — PA
BCBS Federal Standard Option 2026
via Concerta 		Tier 3 - Non-Preferred Brand ✓ — — PA
BCBS Federal Standard Option 2026
via Quillichew 		Tier 3 - Non-Preferred Brand ✓ — — PA
BCBS Federal Standard Option 2026
via Ritalin 		Tier 3 - Non-Preferred Brand ✓ — — PA
BCBS Federal Basic Option 2026
via Concerta 		Tier 3 - Non-Preferred Brand ✓ — — PA
BCBS Federal Basic Option 2026
via Ritalin 		Tier 3 - Non-Preferred Brand ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 19 hours, 7 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Care 2026
via Ritalin 		Tier 1 - Lowest Cost Generic — — ✓ QL
BCBSNC Blue Value 2026
via Ritalin 		Tier 1 - Lowest Cost Generic — — ✓ QL
BCBSNC Blue Advantage 2026
via Ritalin 		Tier 1 - Lowest Cost Generic — — ✓ QL
BCBSNC Blue Home with UNC Health Alliance 2026
via Ritalin 		Tier 1 - Lowest Cost Generic — — ✓ QL
BCBSNC Blue Local 2026
via Ritalin 		Tier 1 - Lowest Cost Generic — — ✓ QL
BCBSNC Blue Value 2026 Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Home with UNC Health Alliance 2026
via Concerta 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Local 2026
via Concerta 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Care 2026
via Concerta 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Advantage 2026
via Concerta 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Advantage 2026 Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Value 2026
via Concerta 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Local 2026 Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Care 2026 Tier 2 - Medium Cost Generic/Brand — — ✓ QL
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 19 hours, 7 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026
via methylphenidate 		Tier 1 - Generic — — ✓ QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 19 hours, 7 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Concerta 		Preferred — — — None
NC Medicaid Preferred Drug List 2026
via Daytrana 		Preferred — — — None
NC Medicaid Preferred Drug List 2026
via Ritalin 		Non-Preferred — — — None
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
NC Medicaid Preferred Drug List 2026
via methylphenidate 		Non-Preferred — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 19 hours, 7 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Ritalin 		Tier 3 - Non-Preferred Brand ✓ — ✓ PA | QL
NC State Health Plan - 70/30 Standard PPO 2026
via Ritalin 		Tier 3 - Non-Preferred Brand ✓ — ✓ PA | QL
NC State Health Plan - 80/20 Plus PPO 2026
via Ritalin 		Tier 3 - Non-Preferred Brand ✓ — ✓ PA | QL
NC State Health Plan - 70/30 Standard PPO 2026
via Quillichew 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Cotempla Xr-Odt 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Quillichew 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Cotempla Xr-Odt 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Quillichew 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Cotempla Xr-Odt 		Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 19 hours, 7 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via methylphenidate 		Tier 3 - Non-Formulary ✓ — — PA
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