Nucynta

Generic: tapentadol

50MG, 100MG, 150MG, 200MG, 250MG — Tablet

OPIOID AGONISTS

Also known as: tapentadol NUCYNTA TABS 50MG, 75MG, 100MG NUCYNTA ER TB12 50MG, 100MG, 150MG, 200MG, 250MG Nucynta Er 50 Mg Tablet Nucynta Er 100 Mg Tablet Nucynta Er 150 Mg Tablet Nucynta Er 200 Mg Tablet Nucynta Er 250 Mg Tablet NUCYNTA ER TB12 50MG, 100MG NUCYNTA ER TB12 150MG, 200MG, 250MG NUCYNTA ER TB12 50MG, 100MG, 150MG,
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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: 18 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Gold with Atrium Health
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Silver with Atrium Health
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Expanded Bronze with Atrium Health
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Complete Gold with Atrium Health
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Focused Silver with Atrium Health
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Elite Bronze with Atrium Health
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Gold
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Silver
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Expanded Bronze
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Elite Bronze
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Everyday Bronze
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver $0 Rx Options
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Complete Gold
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Gold + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Streamlined Silver
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Silver + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Streamlined Silver with Atrium Health
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Enhanced CHF Heart Care Silver $0 Rx Options
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Gold with Atrium Health + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Silver with Atrium Health + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Signature Expanded Bronze + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental
via tapentadol 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 18 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026 Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Basic Option 2026 Tier 2 - Preferred Brand ✓ — — PA
Source: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 18 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver RD CMS Standard
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 2200 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Gold RD CMS Standard
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 7000 HSA Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 3500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 6500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 5500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 3600 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 3000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze CMS Standard Tier 4 - Non-Preferred ✓ — — PA
Connect Silver CMS Standard Tier 4 - Non-Preferred ✓ — — PA
Connect Gold CMS Standard Tier 4 - Non-Preferred ✓ — — PA
Connect myDiabetesCare Bronze Tier 4 - Non-Preferred ✓ — — PA
Connect myDiabetesCare Silver Tier 4 - Non-Preferred ✓ — — PA
Connect Gold 1500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD 6000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD CMS Standard Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD CMS Standard Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 2200 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Gold RD CMS Standard Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 7000 HSA Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 6500 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 5500 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 5000 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 3600 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 3000 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze CMS Standard
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver CMS Standard
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Gold CMS Standard
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect myDiabetesCare Bronze
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect myDiabetesCare Silver
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Gold 1500 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD 5000 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD 6000 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD CMS Standard
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 3500 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 5000 Indiv Med Deductible
via Nucynta Er 		Tier 4 - Non-Preferred ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 18 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Alignment Health AVA (PPO)
via Nucynta Er 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Nucynta Er 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum Select (HMO)
via Nucynta Er 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Nucynta Er 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health smartHMO (HMO)
via Nucynta Er 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health NC Duals (HMO-POS D-SNP)
via Nucynta Er 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum (HMO)
via Nucynta Er 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health AVA (PPO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum Select (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health smartHMO (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health NC Duals (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 18 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via tapentadol 		Non-Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 18 hours, 33 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered — — — None
NC State Health Plan - HDHP 2026 Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered — — — None
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 18 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 4 - Non-Preferred ✓ — ✓ PA | QL
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