Perphenazine-Amitriptyline
2 Mg, 10 Mg — Tablet
Also known as:
perphenazine-amitriptyline tab 2-10 mg
perphenazine-amitriptyline tab 2-25 mg
perphenazine-amitriptyline tab 4-10 mg
perphenazine-amitriptyline tab 4-25 mg
perphenazine-amitriptyline tab 4-50 mg
Perphenazine-Amitriptyline 2 Mg-10 Mg Tablet
Perphenazine-Amitriptyline 2 Mg-25 Mg Tablet
Perphenazine-Amitriptyline 4 Mg-10 Mg Tablet
Perphenazine-Amitriptyline 4 Mg-25 Mg Tablet
Perphenazine-Amitriptyline 4 Mg-50 Mg Tablet
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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| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | — | None |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Local 2026
via Perphenazine/Amitriptylin |
Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
|
BCBSNC Blue Value 2026
via Perphenazine/Amitriptylin |
Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
|
BCBSNC Blue Care 2026
via Perphenazine/Amitriptylin |
Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
|
BCBSNC Blue Advantage 2026
via Perphenazine/Amitriptylin |
Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Perphenazine/Amitriptylin |
Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
Cigna
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |