levomilnacipran HCl
120 mg, 20 mg, 20 mg (2)-40 mg (26), 40 mg, 80 mg — Extended Release Capsule
ANTIDEPRESSANTS AND NON-OPIOID PAIN SYNDROME AGENTS
Also known as:
FETZIMA
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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.
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Advantage 2026
via Fetzima Titration Pack |
Tier 4 - Higher Cost Brand | — | — | ✓ Restricted Access | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Fetzima Titration Pack |
Tier 4 - Higher Cost Brand | — | — | ✓ Restricted Access | QL |
|
BCBSNC Blue Local 2026
via Fetzima Titration Pack |
Tier 4 - Higher Cost Brand | — | — | ✓ Restricted Access | QL |
|
BCBSNC Blue Care 2026
via Fetzima Titration Pack |
Tier 4 - Higher Cost Brand | — | — | ✓ Restricted Access | QL |
|
BCBSNC Blue Value 2026
via Fetzima Titration Pack |
Tier 4 - Higher Cost Brand | — | — | ✓ Restricted Access | QL |