Gocovri
Generic: amantadine
68.5 MG — Capsule
Anti-Parkinson And Restless Leg Syndrome Agents
Also known as:
amantadine
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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.
Cigna
1 planMedicare Part D
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Troy Medicare (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 60 per 30 days | PA | QL |
NC Medicaid PDL
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC Medicaid Preferred Drug List 2026 | Non-Preferred | ✓ | — | — | PA |
|
NC Medicaid Preferred Drug List 2026
via Osmolex |
Non-Preferred | ✓ | — | — | PA |
|
NC Medicaid Preferred Drug List 2026
via Amantadine |
Non-Preferred | ✓ | — | — | PA |