orlistat

Generic: Xenical

100 %, 120 mg — Capsule

Also known as: Xenical orlistat caps 120mg XENICAL

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 15 hours, 51 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Focus 2026	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Standard Option 2026	Tier 1 - Generic	✓	—	—	PA
BCBS Federal Basic Option 2026 via Xenical	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Standard Option 2026 via Xenical	Tier 3 - Non-Preferred Brand	✓	—	—	PA

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 15 hours, 50 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Non-Preferred	✓	—	—	PA
NC Medicaid Preferred Drug List 2026 via Xenical	Non-Preferred	✓	—	—	PA

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 15 hours, 50 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 2 - Non-Preferred Generic	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026	Tier 2 - Non-Preferred Generic	✓	—	—	PA
NC State Health Plan - HDHP 2026	Tier 2 - Non-Preferred Generic	✓	—	—	PA

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 15 hours, 50 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA