fentaNYL Transdermal

37.5 MCG/HR — Patch

Opioid Agonist

Also known as: fentaNYL Transdermal Patch
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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.
Source: CMS QHP JSON  ·  Checked: 11 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 2 - Generic ✓ — ✓ PA | QL
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 2 - Generic ✓ — ✓ PA | QL
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 2 - Generic ✓ — ✓ PA | QL
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 2 - Generic ✓ — ✓ PA | QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 2 - Generic ✓ — ✓ PA | QL
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 2 - Generic ✓ — ✓ PA | QL
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 2 - Generic ✓ — ✓ PA | QL
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 2 - Generic ✓ — ✓ PA | QL
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 2 - Generic ✓ — ✓ PA | QL
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 2 - Generic ✓ — ✓ PA | QL
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 11 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic — — ✓ 10 per 30 days QL
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic — — ✓ 10 per 30 days QL
Troy Medicare (HMO) Tier 2 - Generic — — ✓ 10 per 30 days QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Signature Giveback (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Chronic Care (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
HealthSpring True Choice (PPO) Tier 4 - Non-Preferred — — ✓ 10 per 30 days QL
HealthSpring TotalCare (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 10 per 30 days QL
HealthSpring TotalCare Plus (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 10 per 30 days QL
HealthSpring Preferred (HMO) Tier 4 - Non-Preferred — — ✓ 10 per 30 days QL
HealthSpring Preferred Select (HMO) Tier 4 - Non-Preferred — — ✓ 10 per 30 days QL
HealthSpring Preferred Savings (HMO) Tier 4 - Non-Preferred — — ✓ 10 per 30 days QL
HealthSpring Preferred Plus (HMO) Tier 4 - Non-Preferred — — ✓ 10 per 30 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED CORE 001 NC (HMO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED GIVEBACK 002 NC (HMO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED GIVEBACK 012 NC (HMO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED CHOICE 001 NC (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED CHOICE 003 NC (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED CHOICE 005 NC (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
DEVOTED CHOICE 008 NC (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Blue Medicare PPO Enhanced (PPO) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Blue Medicare Essential Plus (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Blue Medicare Enhanced (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Blue Medicare Choice (HMO) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Blue Medicare Essential (HMO) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Experience Health Medicare Advantage (HMO) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Alignment Health Platinum (HMO) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Alignment Health NC Duals (HMO-POS D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Alignment Health smartHMO (HMO) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Alignment Health Platinum Select (HMO) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
Alignment Health AVA (PPO) Tier 4 - Non-Preferred ✓ — ✓ 15 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Dual (HMO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Value Plus (HMO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Prime (HMO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Signature Care (HMO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Enhanced (HMO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Signature Extra (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — ✓ 10 per 30 days PA | QL
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