ethosuximide capsule

Solution

First Generation — Patients with a diagnosis of seizure disorder are exempt from T/F criteria and may use any first generation product.

Also known as: Zarontin

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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.

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 17 hours, 21 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Focused Silver with Atrium Health + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Expanded Bronze + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Silver + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Gold + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Silver with Atrium Health + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Gold with Atrium Health + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Expanded Bronze via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Silver via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Gold via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Expanded Bronze with Atrium Health via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Silver with Atrium Health via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Standard Gold with Atrium Health via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold + Vision + Adult Dental via Zarontin	Tier 3 - Preferred Brand	—	—	✓	QL

Blue Cross Blue Shield Federal

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 17 hours, 21 minutes ago

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

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 17 hours, 21 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Care 2026 via Zarontin	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Value 2026 via Zarontin	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Advantage 2026 via Zarontin	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Local 2026 via Zarontin	Tier 3 - High Cost Brand	✓	—	—	PA
BCBSNC Blue Home with UNC Health Alliance 2026 via Zarontin	Tier 3 - High Cost Brand	✓	—	—	PA

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 17 hours, 21 minutes ago

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

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 17 hours, 21 minutes ago

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