Mavenclad
Generic: cladribine
10 MG — Tablet
ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ ANOREXIANTS
Also known as:
cladribine
Mavenclad (10 Tabs) Oral Tablet Therapy Pack
Cladribine
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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.
AmeriHealth Caritas NC
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Advantage 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Local 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Care 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
| BCBSNC Blue Value 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
Medicare Part D
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Troy Medicare (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare (HMO)
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via cladribine |
Tier 5 - Specialty | ✓ | — | — | PA |
NC Medicaid PDL
2 plansNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - HDHP 2026
via cladribine |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via cladribine |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via cladribine |
Tier 1 - Preferred Generic | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Bronze Simple Diabetes | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Simple Chronic Care CKM | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
AIAN Cost Share
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
AIAN Cost Share | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Bronze Classic 4700 | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Secure | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Simple Diabetes
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Simple PCP Saver
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Bronze Classic 4700
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Secure
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Classic
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Bronze Elite + PCP Saver Plus
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Gold Classic Standard | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Classic Standard | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Bronze Classic Standard | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Gold Classic Standard
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Classic Standard
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Bronze Classic Standard
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Gold Elite Saver Plus
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Classic | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Simple Diabetes | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Silver Simple PCP Saver | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |
|
Gold Elite Saver Plus | with Atrium Health
via cladribine |
Tier 5 - Specialty | — | — | — | None |