Nighttime Sleep Aid

Generic: doxylamine succinate

25 mg — Tablet

SEDATIVE-HYPNOTIC AGENTS

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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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 7 hours, 58 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Enhanced CHF Heart Care Silver $0 Rx Options
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Expanded Bronze
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Silver
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Gold
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze with Atrium Health
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Focused Silver with Atrium Health
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold with Atrium Health
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Expanded Bronze with Atrium Health
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Silver with Atrium Health
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Gold with Atrium Health
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Expanded Bronze + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Silver + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Gold + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Silver with Atrium Health + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Signature Gold with Atrium Health + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Streamlined Silver
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Streamlined Silver with Atrium Health
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver $0 Rx Options
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze
via doxylamine succinate 		Tier 2 - Generic ✓ — ✓ PA | QL
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 7 hours, 58 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via doxylamine succinate 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via doxylamine succinate 		Tier 2 - Generic ✓ — — PA
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via doxylamine succinate 		Tier 4 - Non-Preferred ✓ — — PA
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via doxylamine succinate 		Tier 4 - Non-Preferred ✓ — — PA
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via doxylamine succinate 		Tier 4 - Non-Preferred ✓ — — PA
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via doxylamine succinate 		Tier 4 - Non-Preferred ✓ — — PA
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via doxylamine succinate 		Tier 4 - Non-Preferred ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals
via doxylamine succinate 		Tier 4 - Non-Preferred ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via doxylamine succinate 		Tier 4 - Non-Preferred ✓ — — PA
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via doxylamine succinate 		Tier 4 - Non-Preferred ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via doxylamine succinate 		Tier 4 - Non-Preferred ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Oct 13, 2026  ·  Checked: 7 hours, 58 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
69803NC0010077
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Classic
via doxylamine succinate 		Tier 2 - Generic — — — None
Secure
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Classic 4700
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Simple PCP Saver
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Simple Diabetes
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Classic Standard
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Classic Standard
via doxylamine succinate 		Tier 2 - Generic — — — None
Gold Classic Standard
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Secure | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Classic | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010074
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010075
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010081
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010082
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010083
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010084
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010085
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Simple Diabetes
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Core Plan
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Core Plan | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Simple Diabetes with Adult Dental & Vision
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010108
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010109
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010110
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010111
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010112
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010113
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010114
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010115
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010116
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010117
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010076
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010078
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010079
via doxylamine succinate 		Tier 2 - Generic — — — None
69803NC0010080
via doxylamine succinate 		Tier 2 - Generic — — — None
Source: Excel (XLSX)  ·  Formulary date: Sep 23, 2026  ·  Checked: 7 hours, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via Wal-som 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Sleep Aid Ultra 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026 Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Nighttime Sleep-aid 		Tier 2 - Brand Formulary (Basic Core) — — — None
TRICARE Uniform Formulary 2026
via Sleep Aid 		Tier 2 - Brand Formulary (Basic Core) — — — None
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 7 hours, 57 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via doxylamine succinate 		Tier 4 - Non-Preferred — — — None
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