Savella
Generic: milnacipran hcl
12.5MG, 25MG, 50MG, 100MG — Tablet
ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ ANOREXIANTS
Also known as:
SAVELLA TABS 12.5MG, 25MG, 50MG, 100MG
SAVELLA MIS TITR PAK
milnacipran hydrochloride
Savella 12.5 Mg Tablet
Savella 25 Mg Tablet
Savella 50 Mg Tablet
Savella 100 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.
Ambetter (Centene)
29 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Complete Gold + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Elite Bronze with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Focused Silver with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Complete Gold with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Everyday Bronze | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Elite Bronze | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Clear Silver with $0 Insulin Options | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Silver | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Silver with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Gold with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Everyday Bronze + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Elite Bronze + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Gold + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Silver + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Complete Gold | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Standard Gold | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
| Everyday Bronze with Atrium Health | Tier 3 - Preferred Brand | ✓ | — | ✓ | PA | QL |
Blue Cross Blue Shield Federal
2 plansBlue Cross Blue Shield of NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Advantage 2026 | Tier 3 - High Cost Brand | — | — | ✓ Restricted Access | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 3 - High Cost Brand | — | — | ✓ Restricted Access | QL |
|
BCBSNC Blue Value 2026
via Savella Titration Pack |
Tier 3 - High Cost Brand | — | — | ✓ Restricted Access | QL |
| BCBSNC Blue Local 2026 | Tier 3 - High Cost Brand | — | — | ✓ Restricted Access | QL |
| BCBSNC Blue Care 2026 | Tier 3 - High Cost Brand | — | — | ✓ Restricted Access | QL |
| BCBSNC Blue Value 2026 | Tier 3 - High Cost Brand | — | — | ✓ Restricted Access | QL |
|
BCBSNC Blue Advantage 2026
via Savella Titration Pack |
Tier 3 - High Cost Brand | — | — | ✓ Restricted Access | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Savella Titration Pack |
Tier 3 - High Cost Brand | — | — | ✓ Restricted Access | QL |
|
BCBSNC Blue Local 2026
via Savella Titration Pack |
Tier 3 - High Cost Brand | — | — | ✓ Restricted Access | QL |
|
BCBSNC Blue Care 2026
via Savella Titration Pack |
Tier 3 - High Cost Brand | — | — | ✓ Restricted Access | QL |
Cigna
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Cigna Plus NC 4-Tier Formulary 2026
via Savella Titration Pack |
Tier 3 - Non-Preferred | — | — | — | None |
| Cigna Plus NC 4-Tier Formulary 2026 | Tier 3 - Non-Preferred | — | — | — | None |
Medicare Part D
51 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Provider Partners North Carolina Essential Plan (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 |
| Provider Partners North Carolina Advantage 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 |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Signature (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Freedom (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Liberty (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Simple (HMO-POS) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Giveback Open (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| HealthTeam Advantage Plan I (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| HealthTeam Advantage Plan II (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Assist Open (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 60 per 30 days | QL |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| Troy Medicare (HMO) | Tier 4 - Non-Preferred | — | ✓ | — | ST |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 4 - Non-Preferred | — | ✓ | ✓ 60 per 30 days | ST | QL |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |