imipramine pamoate
75mg, 100mg, 125mg, 150mg — Capsule
Also known as:
imipramine pamoate caps 75mg, 100mg, 125mg, 150mg
Imipramine Pamoate 75 Mg Capsule
Imipramine Pamoate 100 Mg Capsule
Imipramine Pamoate 125 Mg Capsule
Imipramine Pamoate 150 Mg Capsule
imipramine pamoate caps 75mg, 100mg,
Imipramine Pamoate Oral Capsule
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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| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Complete Gold | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze | Tier 2 - Generic | — | — | — | None |
| Elite Bronze | Tier 2 - Generic | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | — | None |
| Standard Silver | Tier 2 - Generic | — | — | — | None |
| Standard Gold | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — | None |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Silver CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Gold 1500 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect myDiabetesCare Bronze | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze 5500 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver 3500 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver 4400 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver 3000 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze 6500 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect myDiabetesCare Silver | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Gold RD CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver RD CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Gold CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze RD CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
Medicare Part D
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | ✓ | — | ✓ 60 per 30 days | PA | QL |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Troy Medicare (HMO) | Tier 2 - Generic | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Gold Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Classic | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Classic 4700 | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple PCP Saver | Tier 2 - Generic | — | — | ✓ | QL |
| Gold Elite Saver Plus | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple Diabetes | Tier 2 - Generic | — | — | ✓ | QL |
| Secure | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Classic 4700 | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Classic | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple PCP Saver | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Gold Elite Saver Plus | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Simple Diabetes | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| AIAN Cost Share | Tier 2 - Generic | — | — | ✓ | QL |
| AIAN Cost Share | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Secure | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Classic Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Classic Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Gold Classic Standard | Tier 2 - Generic | — | — | ✓ | QL |
| Bronze Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
| Silver Classic Standard | with Atrium Health | Tier 2 - Generic | — | — | ✓ | QL |
TRICARE
1 planUnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Silver Standard (No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Gold Standard (No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Bronze Standard (No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 4 - Non-Preferred | — | — | — | None |