desvenlafaxine
100 mg, 50 mg — Extended Release Tablet
Also known as:
Pristiq
Khedezla
DESVENLAFAXINE ER TB24 50MG, 100MG
DESVENLAFAXINE ER
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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.
Blue Cross Blue Shield Federal
4 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Basic Option 2026
via Pristiq |
Tier 3 - Non-Preferred Brand | — | — | — | None |
| BCBS Federal Standard Option 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Pristiq |
Tier 3 - Non-Preferred Brand | — | — | — | None |
| BCBS Federal Basic Option 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Advantage 2026
via Pristiq |
Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
|
BCBSNC Blue Local 2026
via Pristiq |
Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
|
BCBSNC Blue Care 2026
via Pristiq |
Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
|
BCBSNC Blue Value 2026
via Pristiq |
Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Pristiq |
Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
NC Medicaid PDL
2 plansNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |