Diclegis
Generic: doxylamine-pyridoxine
10MG — Tablet
Also known as:
DICLEGIS TAB 10-10MG
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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.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via doxylamine-pyridoxine |
Tier 2 - Generic | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via doxylamine-pyridoxine |
Tier 2 - Generic | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via doxylamine-pyridoxine |
Tier 2 - Generic | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via doxylamine-pyridoxine |
Tier 2 - Generic | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via doxylamine-pyridoxine |
Tier 2 - Generic | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via doxylamine-pyridoxine |
Tier 2 - Generic | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via doxylamine-pyridoxine |
Tier 2 - Generic | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via doxylamine-pyridoxine |
Tier 2 - Generic | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via doxylamine-pyridoxine |
Tier 2 - Generic | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via doxylamine-pyridoxine |
Tier 2 - Generic | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Standard Option 2026
via doxylamine-pyridoxine |
Tier 1 - Generic | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via doxylamine-pyridoxine |
Tier 1 - Generic | ✓ | — | — | PA |
|
BCBS Federal Focus 2026
via doxylamine-pyridoxine |
Tier 1 - Generic | ✓ | — | — | PA |
| BCBS Federal Standard Option 2026 | Tier 3 - Non-Preferred Brand | ✓ | — | — | PA |
| BCBS Federal Basic Option 2026 | Tier 3 - Non-Preferred Brand | ✓ | — | — | PA |
NC Medicaid PDL
2 plansNC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via doxylamine-pyridoxine |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via doxylamine-pyridoxine |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via doxylamine-pyridoxine |
Tier 1 - Preferred Generic | — | — | — | 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 |
| NC State Health Plan - HDHP 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |