Gilenya
Generic: fingolimod hcl
5MG — Capsule
ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ ANOREXIANTS
Also known as:
GILENYA CAPS .5MG
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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 Essential + No Referrals
via fingolimod hcl |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via fingolimod hcl |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via fingolimod hcl |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via fingolimod hcl |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via fingolimod hcl |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via fingolimod hcl |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via fingolimod hcl |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via fingolimod hcl |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via fingolimod hcl |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via fingolimod hcl |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via fingolimod hcl |
Tier 2 - Preferred Brand | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via fingolimod hcl |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via fingolimod hcl |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Value 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Advantage 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Local 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Care 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
NC Medicaid PDL
1 planNC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via fingolimod hcl |
Tier 4 - Specialty Generic | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - 70/30 Standard PPO 2026
via fingolimod hcl |
Tier 4 - Specialty Generic | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - HDHP 2026
via fingolimod hcl |
Tier 4 - Specialty Generic | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 70/30 Standard PPO 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Not Covered | — | — | — | None |