carbamazepine

Generic: Epitol

100 mg, 100 mg/5 mL, 100 mg/5 mL (5 mL), 200 mg, 200 mg/10 mL, 400 mg — Extended Release Tablet

ANTICONVULSANTS

Also known as: carbamazepine oral suspension 100 carbamazepine oral tablet carbamazepine oral tablet chewable Carbatrol carbamazepine cap er 12hr 100 mg, 200 mg, 300 mg carbamazepine susp 100 mg/5ml carbamazepine tab er 12hr 100 mg, 200 mg, 400 mg carbamazepine tab 200 mg Carbamazepine 100 Mg Chewable Tablet Carbamazepine 100 Mg/5 Ml Oral Suspension Carbamazepine 200 Mg Tablet Carbamazepine Er 100 Mg Capsule Carbamazepine Er 200 Mg Capsule Carbamazepine Er 300 Mg Capsule Carbamazepine Er 100 Mg Tablet Carbamazepine Er 200 Mg Tablet Carbamazepine Er 400 Mg Tablet EPITOL TEGRETOL CARBAMAZEPINE ER TEGRETOL XR
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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: 17 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 2 - Generic — — ✓ QL
Complete Gold Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Standard Gold Tier 2 - Generic — — ✓ QL
Standard Silver Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Standard Silver with Atrium Health + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Standard Gold + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Standard Silver + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Standard Expanded Bronze + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Elite Bronze + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Everyday Bronze + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Complete Gold + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Epitol 		Tier 2 - Generic — — — None
Standard Gold with Atrium Health
via Epitol 		Tier 2 - Generic — — — None
Standard Silver with Atrium Health
via Epitol 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health
via Epitol 		Tier 2 - Generic — — — None
Elite Bronze with Atrium Health
via Epitol 		Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health
via Epitol 		Tier 2 - Generic — — — None
Standard Gold
via Epitol 		Tier 2 - Generic — — — None
Standard Silver
via Epitol 		Tier 2 - Generic — — — None
Complete Gold with Atrium Health
via Epitol 		Tier 2 - Generic — — — None
Standard Expanded Bronze with Atrium Health
via Epitol 		Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options
via Epitol 		Tier 2 - Generic — — — None
Elite Bronze
via Epitol 		Tier 2 - Generic — — — None
Everyday Bronze
via Epitol 		Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Epitol 		Tier 2 - Generic — — — None
Complete Gold
via Epitol 		Tier 2 - Generic — — — None
Standard Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Silver + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze
via Epitol 		Tier 2 - Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Elite Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Complete Gold + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options Tier 2 - Generic — — ✓ QL
Elite Bronze Tier 2 - Generic — — ✓ QL
Everyday Bronze Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Silver with Atrium Health + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Gold + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Silver + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Expanded Bronze + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Complete Gold with Atrium Health + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Focused Silver with Atrium Health + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Expanded Bronze with Atrium Health
via Tegretol 		Tier 3 - Preferred Brand — — — None
Complete Gold with Atrium Health
via Tegretol 		Tier 3 - Preferred Brand — — — None
Focused Silver with Atrium Health
via Tegretol 		Tier 3 - Preferred Brand — — — None
Elite Bronze with Atrium Health
via Tegretol 		Tier 3 - Preferred Brand — — — None
Everyday Bronze with Atrium Health
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Gold
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Silver
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Expanded Bronze
via Tegretol 		Tier 3 - Preferred Brand — — — None
Clear Silver with $0 Insulin Options
via Tegretol 		Tier 3 - Preferred Brand — — — None
Elite Bronze
via Tegretol 		Tier 3 - Preferred Brand — — — None
Everyday Bronze
via Tegretol 		Tier 3 - Preferred Brand — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Tegretol 		Tier 3 - Preferred Brand — — — None
Complete Gold
via Tegretol 		Tier 3 - Preferred Brand — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Elite Bronze + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Everyday Bronze + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Complete Gold + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Gold with Atrium Health
via Tegretol 		Tier 3 - Preferred Brand — — — None
Standard Silver with Atrium Health
via Tegretol 		Tier 3 - Preferred Brand — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Expanded Bronze with Atrium Health
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Silver with Atrium Health
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Gold with Atrium Health
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Complete Gold + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Everyday Bronze + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Elite Bronze + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Expanded Bronze + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Silver + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Gold + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Silver with Atrium Health + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Gold with Atrium Health + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Everyday Bronze
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Elite Bronze
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Clear Silver with $0 Insulin Options
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Expanded Bronze
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Silver
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Standard Gold
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Everyday Bronze with Atrium Health
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Elite Bronze with Atrium Health
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Focused Silver with Atrium Health
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Complete Gold with Atrium Health
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Complete Gold
via Equetro 		Tier 4 - Non-Preferred — ✓ ✓ ST | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via Tegretol-Xr 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Tegretol-Xr 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Tegretol 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Tegretol 		Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: May 1, 2026  ·  Checked: 17 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Care 2026
via Carbatrol 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Value 2026
via Carbatrol 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Advantage 2026
via Carbatrol 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Carbatrol 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Local 2026
via Carbatrol 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Tegretol-Xr 		Tier 3 - High Cost Brand ✓ — — PA
BCBSNC Blue Value 2026
via Tegretol 		Tier 3 - High Cost Brand ✓ — — PA
BCBSNC Blue Value 2026
via Tegretol-Xr 		Tier 3 - High Cost Brand ✓ — — PA
BCBSNC Blue Care 2026
via Tegretol-Xr 		Tier 3 - High Cost Brand ✓ — — PA
BCBSNC Blue Advantage 2026
via Tegretol 		Tier 3 - High Cost Brand ✓ — — PA
BCBSNC Blue Home with UNC Health Alliance 2026
via Tegretol 		Tier 3 - High Cost Brand ✓ — — PA
BCBSNC Blue Local 2026
via Tegretol 		Tier 3 - High Cost Brand ✓ — — PA
BCBSNC Blue Care 2026
via Tegretol 		Tier 3 - High Cost Brand ✓ — — PA
BCBSNC Blue Local 2026
via Tegretol-Xr 		Tier 3 - High Cost Brand ✓ — — PA
BCBSNC Blue Advantage 2026
via Tegretol-Xr 		Tier 3 - High Cost Brand ✓ — — PA
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026
via Epitol 		Tier 1 - Generic — — — None
Cigna Plus NC 4-Tier Formulary 2026 Tier 1 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: May 13, 2026  ·  Checked: 17 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Longevity Health 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 Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic — — — None
PruittHealth Premier (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
Alignment Health smartHMO (HMO) Tier 2 - Generic — — — None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 2 - Generic — — — None
Alignment Health Platinum (HMO) Tier 2 - Generic — — — None
Senior Care (HMO I-SNP) Tier 2 - Generic — — — None
Troy Medicare (HMO) Tier 2 - Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic — — — None
HealthSpring True Choice (PPO) Tier 2 - Generic — — — None
HealthSpring Preferred (HMO) Tier 2 - Generic — — — None
HealthSpring Preferred Select (HMO) Tier 2 - Generic — — — None
HealthSpring Preferred Savings (HMO) Tier 2 - Generic — — — None
HealthSpring Preferred Plus (HMO) Tier 2 - Generic — — — None
Liberty Medicare Advantage (HMO C-SNP) Tier 2 - Generic — — — None
Wellcare Simple Open (PPO) Tier 2 - Generic — — — None
Wellcare Simple (HMO-POS) Tier 2 - Generic — — — None
Wellcare Giveback Open (PPO) Tier 2 - Generic — — — None
Alignment Health AVA (PPO) Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 2 - Generic — — — None
Alignment Health Platinum Select (HMO) Tier 2 - Generic — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 2 - Generic — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — — None
Erickson Advantage Champion (HMO-POS C-SNP) Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — — None
Erickson Advantage Liberty (HMO-POS) Tier 3 - Preferred Brand — — — None
Erickson Advantage Freedom (HMO-POS) Tier 3 - Preferred Brand — — — None
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 3 - Preferred Brand — — — None
Erickson Advantage Signature (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-24 (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-0015 (HMO-POS) Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (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 from UHC NC-0012 (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-0009 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0008 (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-0007 (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-0021 (HMO-POS) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0019 (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-0016 (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-0001 (PPO) Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 3 - Preferred Brand — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) 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) Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 3 - Preferred Brand — — — None
Blue Medicare Essential Plus (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-137 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) 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
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
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Experience Health Medicare Advantage (HMO) Tier 4 - Non-Preferred — — — None
Blue Medicare Essential (HMO) Tier 4 - Non-Preferred — — — None
Blue Medicare Choice (HMO) Tier 4 - Non-Preferred — — — None
Blue Medicare Enhanced (HMO-POS) Tier 4 - Non-Preferred — — — None
Blue Medicare PPO Enhanced (PPO) 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
Aetna Medicare Prime (HMO) Tier 4 - Non-Preferred — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 4 - Non-Preferred — — — None
Troy Medicare (HMO)
via Equetro 		Tier 4 - Non-Preferred — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Equetro 		Tier 4 - Non-Preferred — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Equetro 		Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 4 - Non-Preferred — — — None
Wellcare Assist Open (PPO) Tier 4 - Non-Preferred — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 008 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE 005 NC (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED CHOICE GIVEBACK 004 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
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) 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
Aetna Medicare Value Plus (HMO) Tier 4 - Non-Preferred — — — None
DEVOTED GIVEBACK 012 NC (HMO) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) 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
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
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred — — — None
Aetna Medicare Chronic Care (HMO C-SNP) 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
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Equetro 		Preferred — — — None
NC Medicaid Preferred Drug List 2026
via Carbatrol 		Non-Preferred — — — None
NC Medicaid Preferred Drug List 2026
via Epitol 		Non-Preferred — — — None
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Tegretol 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Tegretol 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Tegretol 		Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: May 29, 2026  ·  Checked: 17 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Basic Core Formulary — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026 Tier 2 - Lower Cost — — — None
UnitedHealthcare NC Individual & Family 2026
via carbamazepine er 		Tier 3 - Mid-Range Cost — — — None
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