pregabalin

25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg — Extended Release Tablet

ANTICONVULSANTS

Also known as: pregabalin oral capsule Lyrica CR pregabalin caps 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg; soln 20mg/ml pregabalin cap 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, Pregabalin 25 Mg Capsule Pregabalin 50 Mg Capsule Pregabalin 75 Mg Capsule Pregabalin 100 Mg Capsule Pregabalin 150 Mg Capsule Pregabalin 200 Mg Capsule Pregabalin 225 Mg Capsule Pregabalin 300 Mg Capsule Pregabalin 20 Mg/Ml Oral Solution PREGABALIN ER LYRICA CR pregabalin caps 25mg, 50mg, 75mg, 100mg,
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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: 22 hours, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Elite Bronze Tier 2 - Generic — ✓ ✓ ST | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 2 - Generic — ✓ ✓ ST | QL
Complete Gold Tier 2 - Generic — ✓ ✓ ST | QL
Standard Silver Tier 2 - Generic — ✓ ✓ ST | QL
Standard Expanded Bronze Tier 2 - Generic — ✓ ✓ ST | QL
Clear Silver with $0 Insulin Options Tier 2 - Generic — ✓ ✓ ST | QL
Everyday Bronze Tier 2 - Generic — ✓ ✓ ST | QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Standard Gold + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Standard Silver + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Standard Expanded Bronze + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Elite Bronze + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Complete Gold + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 2 - Generic — ✓ ✓ ST | QL
Standard Gold with Atrium Health Tier 2 - Generic — ✓ ✓ ST | QL
Standard Silver with Atrium Health Tier 2 - Generic — ✓ ✓ ST | QL
Standard Expanded Bronze with Atrium Health Tier 2 - Generic — ✓ ✓ ST | QL
Complete Gold with Atrium Health Tier 2 - Generic — ✓ ✓ ST | QL
Focused Silver with Atrium Health Tier 2 - Generic — ✓ ✓ ST | QL
Elite Bronze with Atrium Health Tier 2 - Generic — ✓ ✓ ST | QL
Everyday Bronze with Atrium Health Tier 2 - Generic — ✓ ✓ ST | QL
Standard Gold Tier 2 - Generic — ✓ ✓ ST | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 22 hours, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026 Tier 1 - Generic — — ✓ QL
BCBS Federal Standard Option 2026 Tier 1 - Generic — — ✓ QL
BCBS Federal Basic Option 2026 Tier 1 - Generic — — ✓ QL
BCBS Federal Standard Option 2026
via Lyrica 		Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 22 hours, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026
via Lyrica 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Lyrica 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Lyrica 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Lyrica 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 2026
via Lyrica 		Tier 1 - Lowest Cost Generic — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 22 hours, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026 Tier 1 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 22 hours, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Senior Care (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Troy Medicare (HMO) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Liberty Medicare Advantage (HMO C-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
HealthSpring TotalCare (HMO D-SNP) Tier 2 - Generic — — ✓ 60 per 30 days QL
HealthSpring True Choice (PPO) Tier 2 - Generic — — ✓ 60 per 30 days QL
HealthSpring TotalCare Plus (HMO D-SNP) Tier 2 - Generic — — ✓ 60 per 30 days QL
HealthSpring Preferred (HMO) Tier 2 - Generic — — ✓ 60 per 30 days QL
HealthSpring Preferred Select (HMO) Tier 2 - Generic — — ✓ 60 per 30 days QL
HealthSpring Preferred Savings (HMO) Tier 2 - Generic — — ✓ 60 per 30 days QL
HealthSpring Preferred Plus (HMO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Wellcare Simple Open (PPO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Wellcare Simple (HMO-POS) Tier 2 - Generic — — ✓ 60 per 30 days QL
Wellcare Giveback Open (PPO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health Platinum (HMO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health smartHMO (HMO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health Platinum Select (HMO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health AVA (PPO) Tier 2 - Generic — — ✓ 60 per 30 days QL
HealthTeam Advantage Plan I (PPO) Tier 2 - Generic — — ✓ 60 per 30 days QL
HealthTeam Advantage Plan II (PPO) Tier 2 - Generic — — ✓ 60 per 30 days QL
HealthTeam Advantage Vitality Plan (PPO) Tier 2 - Generic — — ✓ 60 per 30 days QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 2 - Generic — — ✓ 60 per 30 days QL
HumanaChoice Giveback H5216-017 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Full Access H5525-034 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice Giveback H5525-035 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED CORE 001 NC (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED GIVEBACK 002 NC (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED GIVEBACK 012 NC (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED CHOICE 001 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED CHOICE 003 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED CHOICE 005 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED CHOICE 008 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Signature (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Enhanced (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Signature (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Enhanced (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Enhanced (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Signature Extra (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Signature (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Signature (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Signature Giveback (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Signature (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Chronic Care (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Dual (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Humana Gold Plus H1036-335 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice H5216-211 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice H5525-049 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice H5525-050 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice H5525-070 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Blue Medicare PPO Enhanced (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Blue Medicare Essential Plus (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Blue Medicare Enhanced (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Blue Medicare Choice (HMO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Blue Medicare Essential (HMO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Experience Health Medicare Advantage (HMO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Dual Select H5525-072 (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice H5525-083 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H6622-025 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H6622-026 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H6622-057 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H6622-060 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H6622-061 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Choice H8145-004 (PFFS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Erickson Advantage Champion (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Erickson Advantage Liberty (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Erickson Advantage Freedom (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Erickson Advantage Signature (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H1036-137 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H1036-233 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Dual Select H1036-307 (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Aetna Medicare Signature (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Value Plus (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Prime (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Signature Care (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Wellcare Dual Liberty Open (PPO D-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Wellcare Assist Open (PPO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Wellcare Dual Access (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 22 hours, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 22 hours, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Lyrica 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Lyrica 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Lyrica 		Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 22 hours, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary ✓ — — PA
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 22 hours, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026 Unknown — — ✓ QL
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