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)

58 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 12 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Enhanced Asthma/COPD Care Silver with $0 Drug Options via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Complete Gold via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Focused Silver with Atrium Health + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Elite Bronze + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Expanded Bronze + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Gold with Atrium Health via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Silver with Atrium Health via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Complete Gold with Atrium Health via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Focused Silver with Atrium Health via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Complete Gold with Atrium Health + Vision + Adult Dental via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Gold via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Silver via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Expanded Bronze via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Elite Bronze via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Everyday Bronze via milnacipran hydrochloride	Tier 2 - Generic	✓	—	✓	PA \| QL
Standard Gold	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Standard Silver	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Standard Expanded Bronze	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Elite Bronze	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Everyday Bronze	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Complete Gold	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 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
Elite Bronze with Atrium Health + 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 + Vision + Adult Dental	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Standard Gold with Atrium Health	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Standard Silver with Atrium Health	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Complete Gold with Atrium Health	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Focused Silver with Atrium Health	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health	Tier 3 - Preferred Brand	✓	—	✓	PA \| QL

Blue Cross Blue Shield Federal

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 12 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026	Tier 3 - Non-Preferred Brand	—	—	✓	QL
BCBS Federal Standard Option 2026	Tier 3 - Non-Preferred Brand	—	—	✓	QL

Blue Cross Blue Shield of NC

15 plans

Source: PDF · Formulary date: May 1, 2026 · Checked: 12 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Value 2026 via Savella Titration Pa	Tier 2 - Medium Cost Generic/Brand	—	—	✓ Restricted Access	QL
BCBSNC Blue Care 2026 via Savella Titration Pa	Tier 2 - Medium Cost Generic/Brand	—	—	✓ Restricted Access	QL
BCBSNC Blue Advantage 2026 via Savella Titration Pa	Tier 2 - Medium Cost Generic/Brand	—	—	✓ Restricted Access	QL
BCBSNC Blue Home with UNC Health Alliance 2026 via Savella Titration Pa	Tier 2 - Medium Cost Generic/Brand	—	—	✓ Restricted Access	QL
BCBSNC Blue Local 2026 via Savella Titration Pa	Tier 2 - Medium Cost Generic/Brand	—	—	✓ Restricted Access	QL
BCBSNC Blue Advantage 2026	Tier 3 - High Cost Brand	—	—	✓ Restricted Access	QL
BCBSNC Blue Value 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 Care 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 Advantage 2026 via Savella Titration Pack	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 Local 2026	Tier 3 - High Cost Brand	—	—	✓ Restricted Access	QL
BCBSNC Blue Care 2026	Tier 3 - High Cost Brand	—	—	✓ Restricted Access	QL

Cigna

2 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 12 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 3 - Non-Preferred	—	—	—	None
Cigna Plus NC 4-Tier Formulary 2026 via Savella Titration Pack	Tier 3 - Non-Preferred	—	—	—	None

Medicare Part D

51 plans

Source: CMS QHP JSON · Formulary date: May 13, 2026 · Checked: 12 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
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
Provider Partners North Carolina Essential Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	✓ 60 per 30 days	QL
UHC Dual Complete NC-S3 (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-V001 (HMO-POS D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage Giveback from UHC NC-14 (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 from UHC NC-0012 (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0011 (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-0008 (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-0007 (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
Wellcare Giveback Open (PPO)	Tier 3 - Preferred Brand	—	—	✓ 60 per 30 days	QL
AARP Medicare Advantage from UHC NC-0017 (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-0004 (PPO)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0001 (PPO)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage Access from UHC NC-23 (PPO)	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-S2 (PPO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
UHC Dual Complete NC-S001 (PPO D-SNP)	Tier 3 - Preferred Brand	—	—	—	None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-0019 (PPO)	Tier 3 - Preferred Brand	—	—	—	None
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 Simple (HMO-POS)	Tier 3 - Preferred Brand	—	—	✓ 60 per 30 days	QL
Wellcare Simple Open (PPO)	Tier 3 - Preferred Brand	—	—	✓ 60 per 30 days	QL
Erickson Advantage Champion (HMO-POS C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
UHC Complete Care NC-28 (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-25 (HMO-POS C-SNP)	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Liberty (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Freedom (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Guardian (HMO-POS I-SNP)	Tier 3 - Preferred Brand	—	—	—	None
Erickson Advantage Signature (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)	Tier 3 - Preferred Brand	—	—	—	None
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
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 4 - Non-Preferred	—	✓	✓ 60 per 30 days	ST \| QL
Troy Medicare (HMO)	Tier 4 - Non-Preferred	—	✓	—	ST

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 12 hours ago

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

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: May 29, 2026 · Checked: 12 hours ago

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

UnitedHealthcare

2 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 11 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026	Unknown	—	✓	✓	ST \| QL
UnitedHealthcare NC Individual & Family 2026 via Savella Titration Pack	Unknown	—	✓	✓	ST \| QL