nortriptyline hcl

10 mg, 10 mg/5 mL, 25 mg, 50 mg — Capsule

Also known as: nortriptyline hcl oral capsule nortriptyline hcl oral solution nortriptyline hcl caps 10mg, 25mg, 50mg, 75mg; soln 10mg/5ml nortriptyline hcl cap 10 mg, 25 mg, 50 mg, 75 mg nortriptyline hcl soln 10 mg/5ml PAMELOR nortriptyline hcl caps 10mg, 25mg, 50mg,

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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.

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 3 hours, 32 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026	Tier 1 - Generic	—	—	—	None
BCBS Federal Focus 2026	Tier 1 - Generic	—	—	—	None
BCBS Federal Standard Option 2026	Tier 1 - Generic	—	—	—	None

Blue Cross Blue Shield of NC

10 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 3 hours, 32 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Local 2026 via Pamelor	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Care 2026 via Pamelor	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Value 2026 via Pamelor	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Advantage 2026 via Pamelor	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Pamelor	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Local 2026	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Care 2026	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Value 2026	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Advantage 2026	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL

NC State Health Plan

6 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 3 hours, 32 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - HDHP 2026 via Pamelor	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Pamelor	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Pamelor	Tier 3 - Non-Preferred Brand	—	—	—	None

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 3 hours, 32 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 1 - Basic Core Formulary	—	—	—	None

UnitedHealthcare

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 3 hours, 32 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026	Tier 3 - Mid-Range Cost	—	—	—	None