Lucemyra
Generic: lofexidine
0.18 MG — Tablet
AGENTS FOR CHEMICAL DEPENDENCY
Also known as:
LUCEMYRA TABS .18MG
Lucemyra Oral Tablet
lofexidine
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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)
34 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Elite Bronze
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Silver
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Gold
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Streamlined Silver with Atrium Health
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Streamlined Silver
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze with Atrium Health
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Silver with Atrium Health
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Gold with Atrium Health
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Complete Gold + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Elite Bronze + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Silver + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Gold + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Complete Gold
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze
via lofexidine |
Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
AmeriHealth Caritas NC
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via lofexidine |
Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | — | — | — | None |
Blue Cross Blue Shield Federal
2 plansMedicare Part D
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via lofexidine |
Tier 5 - Specialty | ✓ | — | ✓ 224 per 14 days | PA | QL |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via lofexidine |
Tier 5 - Specialty | ✓ | — | ✓ 224 per 14 days | PA | QL |
|
Troy Medicare (HMO)
via lofexidine |
Tier 5 - Specialty | ✓ | — | ✓ 224 per 14 days | PA | QL |