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

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 carBAMazepine ER Oral Tablet Extended Release carBAMazepine ER Oral Capsule Extended Release carBAMazepine Oral Tablet Chewable carBAMazepine Oral Suspension carBAMazepine Oral Tablet

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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)

116 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 18 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
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
Standard Silver + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Epitol	Tier 2 - Generic	—	—	—	None
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
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Epitol	Tier 2 - Generic	—	—	—	None
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze with Atrium Health	Tier 2 - Generic	—	—	✓	QL
Standard Gold	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	Tier 2 - Generic	—	—	✓	QL
Standard Expanded Bronze	Tier 2 - Generic	—	—	✓	QL
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
Standard Expanded Bronze with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Complete Gold with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Clear Silver with $0 Insulin Options	Tier 2 - Generic	—	—	✓	QL
Elite Bronze	Tier 2 - Generic	—	—	✓	QL
Everyday Bronze	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 2 - Generic	—	—	✓	QL
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
Standard Expanded Bronze via Epitol	Tier 2 - Generic	—	—	—	None
Complete Gold	Tier 2 - Generic	—	—	✓	QL
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
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 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
Elite Bronze with Atrium Health + Vision + Adult Dental 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
Elite Bronze + Vision + Adult Dental via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze + 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
Complete Gold with Atrium Health + Vision + Adult Dental via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Standard Expanded Bronze + 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 via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Standard Silver via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Standard Gold via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze with Atrium Health via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Elite Bronze with Atrium Health via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Focused Silver with Atrium Health via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold with Atrium Health via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Standard Expanded Bronze with Atrium Health via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Standard Silver with Atrium Health via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Standard Gold with Atrium Health 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
Complete Gold + Vision + Adult Dental via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Everyday 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 Expanded Bronze 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 Gold with Atrium Health + Vision + Adult Dental via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Complete Gold via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
Everyday Bronze via Tegretol	Tier 3 - Preferred Brand	—	—	—	None
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
Complete Gold 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
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Equetro	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
Standard Gold 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 Expanded Bronze with Atrium Health via Equetro	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
Complete Gold with Atrium Health 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
Complete Gold via Equetro	Tier 4 - Non-Preferred	—	✓	✓	ST \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options 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
Focused Silver with Atrium Health 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

AmeriHealth Caritas NC

24 plans

Source: CMS QHP JSON · Checked: 18 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Essential + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Signature + No Referrals via Epitol	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + No Referrals via Epitol	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + No Referrals via Epitol	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Gold Signature + No Referrals via Epitol	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Signature + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Premier + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Gold Premier + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Gold Signature + No Referrals	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via Equetro	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals via Equetro	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Gold Premier + No Referrals via Equetro	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Premier + No Referrals via Equetro	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + No Referrals via Equetro	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals via Equetro	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Gold Signature + No Referrals via Equetro	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + No Referrals via Equetro	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Essential + No Referrals via Equetro	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas Next Silver Signature + No Referrals via Equetro	Tier 4 - Non-Preferred	—	—	—	None

Blue Cross Blue Shield Federal

4 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 18 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
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 Standard Option 2026 via Tegretol-Xr	Tier 3 - Non-Preferred Brand	—	—	—	None
BCBS Federal Basic Option 2026 via Tegretol	Tier 3 - Non-Preferred Brand	—	—	—	None

Blue Cross Blue Shield of NC

15 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 18 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Care 2026 via Tegretol-Xr	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Value 2026 via Tegretol-Xr	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Advantage 2026 via Carbatrol	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Advantage 2026 via Tegretol	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Value 2026 via Carbatrol	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Care 2026 via Carbatrol	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Local 2026 via Carbatrol	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Home with UNC Health Alliance 2026 via Carbatrol	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 Value 2026 via Tegretol	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Care 2026 via Tegretol	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Advantage 2026 via Tegretol-Xr	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Home with UNC Health Alliance 2026 via Tegretol-Xr	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Local 2026 via Tegretol-Xr	Tier 3 - High Cost Brand	✓	—	—	PA

Cigna

60 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 18 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Silver 3500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard via Epitol	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard via Epitol	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard via Epitol	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard via Epitol	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard via Epitol	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard via Epitol	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect Silver 4400 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect Silver 3500 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze via Epitol	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via Epitol	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver via Epitol	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Silver 4400 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Silver 3500 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver via carbamazepine er	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver 4400 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard	Tier 2 - Generic	—	—	—	None

Medicare Part D

283 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 18 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
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
PruittHealth Premier (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
PruittHealth Premier (HMO I-SNP) via carbamazepine er	Tier 1 - Preferred Generic	—	—	—	None
NHC Advantage (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
NHC Advantage (HMO I-SNP) via carbamazepine er	Tier 1 - Preferred Generic	—	—	—	None
Liberty Medicare Dual Plan (HMO D-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) via carbamazepine er	Tier 1 - Preferred Generic	—	—	—	None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) via carbamazepine er	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Advantage Plan (HMO I-SNP) via carbamazepine er	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Community Plan (HMO I-SNP) via carbamazepine er	Tier 1 - Preferred Generic	—	—	—	None
Longevity Health Plan (HMO I-SNP) via carbamazepine er	Tier 1 - Preferred Generic	—	—	—	None
Longevity Health Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
Provider Partners North Carolina Essential Plan (HMO I-SNP) via carbamazepine er	Tier 1 - Preferred Generic	—	—	—	None
Alignment Health Heart & Diabetes Care (HMO C-SNP)	Tier 2 - Generic	—	—	—	None
Alignment Health AVA (PPO)	Tier 2 - Generic	—	—	—	None
Troy Medicare (HMO) via carbamazepine er	Tier 2 - Generic	—	—	—	None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via carbamazepine er	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) via carbamazepine er	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 2 - Generic	—	—	—	None
HealthSpring TotalCare (HMO D-SNP) via carbamazepine er	Tier 2 - Generic	—	—	—	None
HealthSpring TotalCare Plus (HMO D-SNP) via carbamazepine er	Tier 2 - Generic	—	—	—	None
Senior Care (HMO I-SNP) via carbamazepine er	Tier 2 - Generic	—	—	—	None
Senior Care (HMO I-SNP)	Tier 2 - Generic	—	—	—	None
HealthSpring Preferred (HMO) via carbamazepine er	Tier 2 - Generic	—	—	—	None
HealthSpring Preferred Select (HMO) via carbamazepine er	Tier 2 - Generic	—	—	—	None
HealthSpring Preferred Savings (HMO) via carbamazepine er	Tier 2 - Generic	—	—	—	None
HealthSpring Preferred Plus (HMO) via carbamazepine er	Tier 2 - Generic	—	—	—	None
HealthSpring Preferred (HMO)	Tier 2 - Generic	—	—	—	None
HealthSpring Preferred Select (HMO)	Tier 2 - Generic	—	—	—	None
Wellcare Giveback Open (PPO)	Tier 2 - Generic	—	—	—	None
HealthSpring Preferred Savings (HMO)	Tier 2 - Generic	—	—	—	None
Wellcare Giveback Open (PPO) via carbamazepine er	Tier 2 - Generic	—	—	—	None
Wellcare Simple (HMO-POS)	Tier 2 - Generic	—	—	—	None
Wellcare Simple Open (PPO)	Tier 2 - Generic	—	—	—	None
Wellcare Simple (HMO-POS) via carbamazepine er	Tier 2 - Generic	—	—	—	None
Wellcare Simple Open (PPO) via carbamazepine er	Tier 2 - Generic	—	—	—	None
Liberty Medicare Advantage (HMO C-SNP)	Tier 2 - Generic	—	—	—	None
Liberty Medicare Advantage (HMO C-SNP) via carbamazepine er	Tier 2 - Generic	—	—	—	None
Alignment Health Platinum (HMO)	Tier 2 - Generic	—	—	—	None
Alignment Health NC Duals (HMO-POS D-SNP)	Tier 2 - Generic	—	—	—	None
Alignment Health smartHMO (HMO)	Tier 2 - Generic	—	—	—	None
HealthSpring Preferred Plus (HMO)	Tier 2 - Generic	—	—	—	None
HealthSpring True Choice (PPO) via carbamazepine er	Tier 2 - Generic	—	—	—	None
HealthSpring True Choice (PPO)	Tier 2 - Generic	—	—	—	None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)	Tier 2 - Generic	—	—	—	None
Alignment Health Platinum Select (HMO)	Tier 2 - Generic	—	—	—	None
Erickson Advantage Champion (HMO-POS C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-S001 (PPO D-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-S2 (PPO D-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage Access from UHC NC-23 (PPO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0001 (PPO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0004 (PPO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0016 (PPO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0017 (PPO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0019 (PPO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-D001 (HMO-POS D-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-S3 (HMO-POS D-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-24 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Signature (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Guardian (HMO-POS I-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Freedom (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Liberty (HMO-POS) via carbamazepine er	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 carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
UHC Complete Care NC-27 (HMO-POS C-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
UHC Complete Care NC-28 (HMO-POS C-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Champion (HMO-POS C-SNP) via carbamazepine er	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
HealthSpring TotalCare (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
HealthSpring TotalCare Plus (HMO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare PPO Enhanced (PPO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Essential Plus (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Enhanced (HMO-POS) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Choice (HMO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Blue Medicare Essential (HMO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Experience Health Medicare Advantage (HMO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Healthy Blue + Medicare (HMO-POS D-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health Platinum (HMO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health NC Duals (HMO-POS D-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health smartHMO (HMO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health Platinum Select (HMO) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health Heart & Diabetes Care (HMO C-SNP) via carbamazepine er	Tier 3 - Preferred Brand	—	—	—	None
Alignment Health AVA (PPO) via carbamazepine er	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
Aetna Medicare Signature (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-060 (HMO-POS) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-061 (HMO-POS) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Choice H8145-004 (PFFS) via carbamazepine er	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) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED GIVEBACK 012 NC (HMO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED GIVEBACK 002 NC (HMO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED CORE 001 NC (HMO) via carbamazepine er	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 DUAL 009 NC (HMO D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) via carbamazepine er	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 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
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED DUAL FULL 013 NC (HMO D-SNP) via carbamazepine er	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 Chronic Care Value (HMO C-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Chronic Care (HMO C-SNP) via carbamazepine er	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
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
Aetna Medicare Signature (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature Giveback (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature Extra (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Enhanced (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Enhanced (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Enhanced (HMO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Full Dual Care (HMO D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature Care (HMO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Prime (HMO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Value Plus (HMO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (HMO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Dual (HMO D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Aetna Medicare Signature (HMO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Blue Medicare PPO Enhanced (PPO)	Tier 4 - Non-Preferred	—	—	—	None
Blue Medicare Essential Plus (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Blue Medicare Enhanced (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Blue Medicare Choice (HMO)	Tier 4 - Non-Preferred	—	—	—	None
Blue Medicare Essential (HMO)	Tier 4 - Non-Preferred	—	—	—	None
Experience Health Medicare Advantage (HMO)	Tier 4 - Non-Preferred	—	—	—	None
Healthy Blue + Medicare (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
HealthTeam Advantage Plan I (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Plan II (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Vitality Plan (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) via carbamazepine er	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
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
DEVOTED CHOICE 001 NC (PPO)	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED CHOICE GIVEBACK 009 NC (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED CHOICE 008 NC (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED CHOICE GIVEBACK 006 NC (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
AmeriHealth Caritas VIP Care (HMO D-SNP) via Equetro	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED CHOICE 005 NC (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED CHOICE GIVEBACK 004 NC (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Wellcare Dual Liberty Open (PPO D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Wellcare Assist Open (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Wellcare Dual Access (HMO-POS D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Wellcare Dual Liberty (HMO-POS D-SNP) via carbamazepine er	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) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Wellcare Dual Reserve (HMO-POS D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED CHOICE 003 NC (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED CHOICE GIVEBACK 002 NC (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
DEVOTED CHOICE 001 NC (PPO) via carbamazepine er	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 H1036-137 (HMO-POS) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H1036-233 (HMO-POS) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H1036-307 (HMO D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus Giveback H1036-318 (HMO-POS) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H1036-335 (HMO-POS) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice Giveback H5216-017 (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5216-211 (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Full Access H5525-034 (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice Giveback H5525-035 (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-049 (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-050 (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-070 (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H5525-072 (PPO D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-083 (PPO) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-025 (HMO-POS) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-026 (HMO-POS) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Dual Select H6622-027 (HMO-POS D-SNP) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H6622-057 (HMO-POS) via carbamazepine er	Tier 4 - Non-Preferred	—	—	—	None

NC Medicaid PDL

4 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 18 hours, 20 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	Non-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 State Health Plan

3 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 18 hours, 20 minutes ago

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

Oscar Health

56 plans

Source: CMS QHP JSON · Checked: 18 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Silver Simple Diabetes via Epitol	Tier 2 - Generic	—	—	—	None
Secure \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Silver Classic \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Gold Elite Saver Plus \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
AIAN Cost Share via Epitol	Tier 2 - Generic	—	—	—	None
AIAN Cost Share \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus via Epitol	Tier 2 - Generic	—	—	—	None
Silver Classic via Epitol	Tier 2 - Generic	—	—	—	None
Secure via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 via Epitol	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver via Epitol	Tier 2 - Generic	—	—	—	None
Gold Elite Saver Plus via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Simple Diabetes \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple Chronic Care CKM \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health	Tier 2 - Generic	—	—	—	None
AIAN Cost Share	Tier 2 - Generic	—	—	—	None
AIAN Cost Share \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Gold Classic Standard via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard via Epitol	Tier 2 - Generic	—	—	—	None
Silver Classic Standard \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Silver Classic Standard via Epitol	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard	Tier 2 - Generic	—	—	—	None
Silver Classic Standard	Tier 2 - Generic	—	—	—	None
Gold Classic Standard	Tier 2 - Generic	—	—	—	None
Bronze Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Gold Classic Standard \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Elite + PCP Saver Plus	Tier 2 - Generic	—	—	—	None
Silver Classic	Tier 2 - Generic	—	—	—	None
Secure	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver	Tier 2 - Generic	—	—	—	None
Gold Elite Saver Plus	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes	Tier 2 - Generic	—	—	—	None
Secure \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Classic 4700 \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Gold Classic Standard \| with Atrium Health via Epitol	Tier 2 - Generic	—	—	—	None
Silver Classic \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple Diabetes \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Silver Simple PCP Saver \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Gold Elite Saver Plus \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health	Tier 2 - Generic	—	—	—	None
Bronze Simple Chronic Care CKM \| with Atrium Health	Tier 2 - Generic	—	—	—	None

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jun 24, 2026 · Checked: 18 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 1 - Basic Core Formulary	—	—	—	None

UnitedHealthcare

26 plans

Source: PDF · Formulary date: Jun 23, 2026 · Checked: 18 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Standard+ Dental + Vision (No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Standard (No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Standard (No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Standard (No Referrals) via Epitol	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Standard+ Dental + Vision (No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Bronze Standard (No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Gold Standard (No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Silver Standard (No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals	Tier 3 - Preferred Brand	—	—	—	None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)	Tier 3 - Preferred Brand	—	—	—	None