doxylamine-pyridoxine

10 mg — Tablet

Also known as: Diclegis doxylamine-pyridoxine tab delayed release 10- 10 mg doxylamine-pyridoxine tab delayed release 10- Doxylamine-Pyridoxine Oral Tablet Delayed Release

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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

Source: CMS QHP JSON · Checked: 10 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Signature + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Bronze Essential + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Silver Essential + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Bronze Premier + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Gold Premier + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Bronze Signature + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 2 - Generic	✓	—	—	PA
AmeriHealth Caritas Next Gold Signature + No Referrals	Tier 2 - Generic	✓	—	—	PA

Blue Cross Blue Shield Federal

5 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 10 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Basic Option 2026	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Focus 2026	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Standard Option 2026 via Diclegis	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Basic Option 2026 via Diclegis	Tier 3 - Non-Preferred Brand	✓	—	—	PA

NC Medicaid PDL

2 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 10 hours, 20 minutes ago

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

NC State Health Plan

6 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 10 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Diclegis	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Diclegis	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - HDHP 2026 via Diclegis	Tier 3 - Non-Preferred Brand	—	—	—	None