Palsonify

Generic: paltusotine HCl

20 MG, 30 MG — Tablet

Also known as: PALSONIFY TABS 20MG, 30MG

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

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 18 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 18 hours, 53 minutes ago

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

1 plan

Source: Excel (XLSX) · Formulary date: Oct 29, 2026 · Checked: 18 hours, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA PA: TPA - SELECT DRUGS REQUIRES PRIOR AUTHORIZATION (NEW TO MARKET DRUGS)