Nucynta Er

Generic: tapentadol

100 MG

Opioid Analgesics, Long-acting

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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: 12 hours, 50 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: 12 hours, 50 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via Nucynta 		Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Basic Option 2026
via Nucynta 		Tier 2 - Preferred Brand ✓ — — PA
Source: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 12 hours, 50 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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 Silver RD 3500 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 6500 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 5500 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 5000 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 3600 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver 3000 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Gold CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect myDiabetesCare Bronze
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect myDiabetesCare Silver
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Gold 1500 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD 5000 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD 6000 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze RD CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 5000 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 2200 Indiv Med Deductible
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Gold RD CMS Standard
via Nucynta 		Tier 4 - Non-Preferred ✓ — — PA
Connect Bronze 7000 HSA Indiv Med Deductible
via Nucynta 		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 3500 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Connect Silver RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 12 hours, 50 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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
Alignment Health Platinum (HMO) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum (HMO)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health AVA (PPO)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Platinum Select (HMO)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health smartHMO (HMO)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Alignment Health NC Duals (HMO-POS D-SNP)
via Nucynta 		Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 12 hours, 50 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: 12 hours, 50 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Nucynta 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Nucynta 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Nucynta 		Not Covered — — — None
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 12 hours, 50 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)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Nucynta 		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)
via Nucynta 		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)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Nucynta 		Tier 4 - Non-Preferred ✓ — ✓ PA | QL
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