DARIFENACIN ER

7.5 MG

Cholinergic Muscarinic Antagonist

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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: Sep 22, 2026  ·  Checked: 11 hours, 14 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via darifenacin hydrobromide 		Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Silver Premier + No Referrals
via darifenacin hydrobromide 		Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via darifenacin hydrobromide 		Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via darifenacin hydrobromide 		Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via darifenacin hydrobromide 		Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via darifenacin hydrobromide 		Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via darifenacin hydrobromide 		Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via darifenacin hydrobromide 		Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via darifenacin hydrobromide 		Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via darifenacin hydrobromide 		Tier 2 - Generic — ✓ — ST
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 11 hours, 14 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026
via darifenacin hydrobromide 		Tier 1 - Generic — — — None
BCBS Federal Focus 2026
via darifenacin hydrobromide 		Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026
via darifenacin hydrobromide 		Tier 1 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 15, 2026  ·  Checked: 11 hours, 14 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 7000 HSA Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 3600 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 3000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze CMS Standard Tier 2 - Generic — — — None
Connect Silver CMS Standard Tier 2 - Generic — — — None
Connect Gold CMS Standard Tier 2 - Generic — — — None
Connect myDiabetesCare Bronze Tier 2 - Generic — — — None
Connect myDiabetesCare Silver Tier 2 - Generic — — — None
Connect Gold 1500 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 RD CMS Standard Tier 2 - Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD CMS Standard Tier 2 - Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Gold RD CMS Standard Tier 2 - Generic — — — None
Connect Bronze 6500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze 5500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 11 hours, 14 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Troy Medicare (HMO) Tier 2 - Generic — ✓ — ST
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic — ✓ — ST
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic — ✓ ✓ 30 per 30 days ST | QL
DEVOTED CORE 001 NC (HMO) Tier 4 - Non-Preferred — ✓ ✓ 30 per 30 days ST | QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 4 - Non-Preferred — ✓ ✓ 30 per 30 days ST | QL
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 4 - Non-Preferred — ✓ ✓ 30 per 30 days ST | QL
DEVOTED GIVEBACK 012 NC (HMO) Tier 4 - Non-Preferred — ✓ ✓ 30 per 30 days ST | QL
HealthSpring True Choice (PPO) Tier 4 - Non-Preferred — — — None
DEVOTED GIVEBACK 002 NC (HMO) Tier 4 - Non-Preferred — ✓ ✓ 30 per 30 days ST | QL
HealthSpring TotalCare (HMO D-SNP) Tier 4 - Non-Preferred — — — None
HealthSpring Preferred (HMO) Tier 4 - Non-Preferred — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Select (HMO) Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Savings (HMO) Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Plus (HMO) Tier 4 - Non-Preferred — — — None
Source: Excel (XLSX)  ·  Formulary date: Sep 23, 2026  ·  Checked: 11 hours, 14 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via darifenacin hydrobromide 		Tier 3 - Non-Formulary — ✓ — ST Step therapy: 1270/99001/157714&157715 ST OAB STP7651 COT DOD/ST OAB STP7651 RX<1/180 DOD
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