Mayzent Starter Pack
Generic: siponimod fumarate
0.25 MG — Tablet
ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ ANOREXIANTS
Also known as:
MAYZENT STARTER PACK TBPK .25MG
Mayzent Starter Pack Oral Tablet Therapy Pack
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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
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze 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 |
| 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 Gold Signature + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
3 plans| 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 |
Blue Cross Blue Shield of NC
5 plans| 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 |
Medicare Part D
16 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | ✓ 14 per 365 days | PA | QL |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | ✓ 14 per 365 days | PA | QL |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | ✓ 14 per 365 days | PA | QL |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 7 per 28 days | QL |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 7 per 28 days | QL |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 7 per 28 days | QL |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 7 per 28 days | QL |
| Senior Care (HMO I-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 7 per 28 days | QL |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 7 per 28 days | QL |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 4 - Non-Preferred | ✓ | — | ✓ 14 per 365 days | PA | QL |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 14 per 365 days | PA | QL |
| HealthTeam Advantage Plan II (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 14 per 365 days | PA | QL |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | ✓ 7 per 180 days | PA | QL |
| HealthTeam Advantage Plan I (PPO) | Tier 4 - Non-Preferred | ✓ | — | ✓ 14 per 365 days | PA | QL |
| Troy Medicare (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
NC Medicaid PDL
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via Mayzent Starter Pack Tbpk .25Mg |
Tier 5 - Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Mayzent Starter Pack Tbpk .25Mg |
Tier 5 - Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - HDHP 2026
via Mayzent Starter Pack Tbpk .25Mg |
Tier 5 - Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |