Ingrezza Sprinkle Capsules

Generic: valbenazine

Movement Disorders

Also known as: valbenazine
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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  ·  Formulary date: Sep 22, 2026  ·  Checked: 13 hours, 47 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Ingrezza 		Tier 5 - Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 47 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via Ingrezza 		Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Standard Option 2026
via Ingrezza 		Tier 5 - Non-Preferred Specialty ✓ — — PA
BCBS Federal Basic Option 2026
via Ingrezza 		Tier 5 - Non-Preferred Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 47 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
BCBSNC Blue Advantage 2026
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
BCBSNC Blue Care 2026
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
BCBSNC Blue Local 2026
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 13 hours, 47 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Ingrezza 		Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
Liberty Medicare Dual Plan (HMO D-SNP)
via Ingrezza 		Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Ingrezza 		Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Ingrezza 		Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
Longevity Health Plan (HMO I-SNP)
via Ingrezza 		Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Ingrezza 		Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
PruittHealth Premier (HMO I-SNP)
via Ingrezza 		Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
NHC Advantage (HMO I-SNP)
via Ingrezza 		Tier 1 - Preferred Generic ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Alignment Health Platinum (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Alignment Health NC Duals (HMO-POS D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Alignment Health smartHMO (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Alignment Health Platinum Select (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Erickson Advantage Signature (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Erickson Advantage Guardian (HMO-POS I-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Erickson Advantage Champion (HMO-POS C-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Erickson Advantage Freedom (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Erickson Advantage Liberty (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Liberty Medicare Advantage (HMO C-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Alignment Health AVA (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthSpring True Choice (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Healthy Blue + Medicare (HMO-POS D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthSpring TotalCare (HMO D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthSpring Preferred (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthSpring TotalCare Plus (HMO D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthSpring Preferred Select (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthSpring Preferred Savings (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthSpring Preferred Plus (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Plan I (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Plan II (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Vitality Plan (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Wellcare Dual Liberty (HMO-POS D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 28 per 180 days PA | QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-S001 (PPO D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
UHC Dual Complete NC-S2 (PPO D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Wellcare Simple Open (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 28 per 180 days PA | QL
Wellcare Dual Liberty Open (PPO D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 28 per 180 days PA | QL
Wellcare Assist Open (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 28 per 180 days PA | QL
Wellcare Giveback Open (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 28 per 180 days PA | QL
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Blue Medicare PPO Enhanced (PPO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Blue Medicare Essential Plus (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Blue Medicare Enhanced (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Blue Medicare Choice (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Blue Medicare Essential (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Experience Health Medicare Advantage (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Wellcare Simple (HMO-POS)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 28 per 180 days PA | QL
Wellcare Dual Access (HMO-POS D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 28 per 180 days PA | QL
Wellcare Dual Reserve (HMO-POS D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 28 per 180 days PA | QL
Senior Care (HMO I-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Troy Medicare (HMO)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ 30 per 30 days PA | QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 47 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 47 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Ingrezza 		Tier 5 - Preferred Brand Specialty ✓ — ✓ PA | QL
NC State Health Plan - 70/30 Standard PPO 2026
via Ingrezza 		Tier 5 - Preferred Brand Specialty ✓ — ✓ PA | QL
NC State Health Plan - 80/20 Plus PPO 2026
via Ingrezza 		Tier 5 - Preferred Brand Specialty ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 13 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Ingrezza 		Tier 5 - Specialty ✓ — ✓ PA | QL
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