Desvenlafaxine Er

Generic: desvenlafaxine

100 MG, 50 MG — Extended Release Tablet

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

4 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 8 hours, 59 minutes ago

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

5 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 8 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Care 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 Value 2026 via Pristiq	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Advantage 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

2 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 8 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via desvenlafaxine	Non-Preferred	—	—	—	None
NC Medicaid Preferred Drug List 2026 via Pristiq	Non-Preferred	—	—	—	None

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 8 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 70/30 Standard PPO 2026 via desvenlafaxine	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via desvenlafaxine	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - HDHP 2026 via desvenlafaxine	Tier 3 - Non-Preferred Brand	—	—	—	None

2 plans

Source: Excel (XLSX) · Formulary date: Sep 23, 2026 · Checked: 8 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via Pristiq	Tier 2 - Brand Formulary	—	—	—	None
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	✓	—	ST Step therapy: 1270/99001/145638 ST DESVENLAFAXINE STP7109 RX<1/180 DOD PA REQUIRED