carbidopa/levodopa

10 mg-100 mg, 25 mg-100 mg, 25 mg-250 mg — Tablet

Also known as: SINEMET CARBIDOPA-LEVODOPA DHIVY

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

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 12 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026 via Carbidopa-Levodopa	Tier 1 - Generic	—	—	—	None

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 12 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Carbidopa-Levodopa	Preferred	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 12 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 1 - Basic Core Formulary	✓	—	—	PA

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 12 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026 via Carbidopa-Levodopa	Tier 3 - Mid-Range Cost	—	—	—	None