Lampit

Generic: nifurtimox

30MG, 120MG — Tablet

ANTIMALARIALS

Also known as: nifurtimox LAMPIT TABS 30MG, 120MG

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 1 hour, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026 Tier 4 - Higher Cost Brand Limited Distribution None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 4 - Higher Cost Brand Limited Distribution None
BCBSNC Blue Local 2026 Tier 4 - Higher Cost Brand Limited Distribution None
BCBSNC Blue Care 2026 Tier 4 - Higher Cost Brand Limited Distribution None
BCBSNC Blue Value 2026 Tier 4 - Higher Cost Brand Limited Distribution None
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 1 hour, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 4 - Non-Preferred None
Humana Gold Plus H6622-060 (HMO-POS) Tier 4 - Non-Preferred None
Humana Gold Plus H6622-061 (HMO-POS) Tier 4 - Non-Preferred None
Humana Gold Choice H8145-004 (PFFS) Tier 4 - Non-Preferred None
Blue Medicare PPO Enhanced (PPO) Tier 4 - Non-Preferred None
Blue Medicare Essential Plus (HMO-POS) Tier 4 - Non-Preferred None
Blue Medicare Enhanced (HMO-POS) Tier 4 - Non-Preferred None
Blue Medicare Choice (HMO) Tier 4 - Non-Preferred None
Blue Medicare Essential (HMO) Tier 4 - Non-Preferred None
Experience Health Medicare Advantage (HMO) Tier 4 - Non-Preferred None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 4 - Non-Preferred None
Alignment Health Platinum (HMO) Tier 4 - Non-Preferred None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 4 - Non-Preferred None
Alignment Health smartHMO (HMO) Tier 4 - Non-Preferred None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 4 - Non-Preferred None
Alignment Health Platinum Select (HMO) Tier 4 - Non-Preferred None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 4 - Non-Preferred None
Alignment Health AVA (PPO) Tier 4 - Non-Preferred None
Humana Gold Plus H1036-137 (HMO-POS) Tier 4 - Non-Preferred None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 4 - Non-Preferred None
Humana Gold Plus H1036-233 (HMO-POS) Tier 4 - Non-Preferred None
Humana Dual Select H1036-307 (HMO D-SNP) Tier 4 - Non-Preferred None
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 4 - Non-Preferred None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 4 - Non-Preferred None
Humana Gold Plus H1036-335 (HMO-POS) Tier 4 - Non-Preferred None
HumanaChoice Giveback H5216-017 (PPO) Tier 4 - Non-Preferred None
HumanaChoice H5216-211 (PPO) Tier 4 - Non-Preferred None
Humana Full Access H5525-034 (PPO) Tier 4 - Non-Preferred None
HumanaChoice Giveback H5525-035 (PPO) Tier 4 - Non-Preferred None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 4 - Non-Preferred None
HumanaChoice H5525-049 (PPO) Tier 4 - Non-Preferred None
HumanaChoice H5525-050 (PPO) Tier 4 - Non-Preferred None
HumanaChoice H5525-070 (PPO) Tier 4 - Non-Preferred None
Humana Dual Select H5525-072 (PPO D-SNP) Tier 4 - Non-Preferred None
HumanaChoice H5525-083 (PPO) Tier 4 - Non-Preferred None
Humana Gold Plus H6622-025 (HMO-POS) Tier 4 - Non-Preferred None
Humana Gold Plus H6622-026 (HMO-POS) Tier 4 - Non-Preferred None
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 4 - Non-Preferred None
Humana Gold Plus H6622-057 (HMO-POS) Tier 4 - Non-Preferred None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 1 hour, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026 Tier 3 - Non-Preferred Brand None
NC State Health Plan - HDHP 2026 Tier 3 - Non-Preferred Brand None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 3 - Non-Preferred Brand None
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