Mayzent

Generic: siponimod

25MG, 1MG, 2MG — Tablet

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ ANOREXIANTS

Also known as: siponimod MAYZENT TABS .25MG, 1MG, 2MG Mayzent Oral Tablet

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  ·  Checked: 19 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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 Premier + 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
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 5 - Specialty PA
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 19 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026 Tier 2 - Preferred Brand PA
BCBS Federal Standard Option 2026 Tier 4 - Preferred Specialty PA
BCBS Federal Basic Option 2026 Tier 4 - Preferred Specialty PA
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 19 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026 Tier 5 - Specialty Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Advantage 2026 Tier 5 - Specialty Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 5 - Specialty Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Local 2026 Tier 5 - Specialty Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Care 2026 Tier 5 - Specialty Restricted Access; Limited Distribution PA | QL
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 19 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic 30 per 30 days PA | QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic 30 per 30 days PA | QL
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic 30 per 30 days PA | QL
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic 30 per 30 days QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic 30 per 30 days QL
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic 30 per 30 days QL
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic 30 per 30 days QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 5 - Specialty PA
Senior Care (HMO I-SNP) Tier 5 - Specialty 30 per 30 days QL
Liberty Medicare Advantage (HMO C-SNP) Tier 5 - Specialty 30 per 30 days QL
Troy Medicare (HMO) Tier 5 - Specialty PA
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 5 - Specialty 30 per 30 days PA | QL
HealthTeam Advantage Vitality Plan (PPO) Tier 5 - Specialty 30 per 30 days PA | QL
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 5 - Specialty 30 per 30 days PA | QL
HealthTeam Advantage Plan II (PPO) Tier 5 - Specialty 30 per 30 days PA | QL
HealthTeam Advantage Plan I (PPO) Tier 5 - Specialty 30 per 30 days PA | QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 19 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 5 - Preferred Brand Specialty PA | QL
NC State Health Plan - 80/20 Plus PPO 2026 Tier 5 - Preferred Brand Specialty PA | QL
NC State Health Plan - 70/30 Standard PPO 2026 Tier 5 - Preferred Brand Specialty PA | QL
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