Subvenite

Generic: lamotrigine

25mg, 100mg, 150mg, 200mg — Tablet

Glutamate Reducing Agents

Also known as: subvenite tabs 25mg, 100mg, 150mg, 200mg subvenite kit start 49 subvenite kit start 98 lamotrigine Subvenite 25 Mg Tablet Subvenite 100 Mg Tablet Subvenite 150 Mg Tablet Subvenite 200 Mg Tablet Subvenite Tablet Starter Kit (Blue) Subvenite Tablet Starter Kit (Green) Subvenite Tablet Starter Kit (Orange) Subvenite Tabs 25mg, 100mg, 150mg, 200mg Subvenite Kit Start 49 Subvenite Kit Start 98
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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: 1 hour, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold with Atrium Health + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Gold + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Silver + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Everyday Bronze
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Elite Bronze
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Clear Silver with $0 Insulin Options
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Silver
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Gold
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Complete Gold + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Elite Bronze + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Complete Gold Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 2 - Generic — — — None
Everyday Bronze Tier 2 - Generic — — — None
Elite Bronze Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options Tier 2 - Generic — — — None
Standard Expanded Bronze Tier 2 - Generic — — — None
Standard Silver Tier 2 - Generic — — — None
Standard Gold Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health Tier 2 - Generic — — — None
Standard Gold + Vision + Adult Dental Tier 2 - Generic — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Standard Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Standard Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Elite Bronze with Atrium Health Tier 2 - Generic — — — None
Focused Silver with Atrium Health Tier 2 - Generic — — — None
Complete Gold with Atrium Health Tier 2 - Generic — — — None
Standard Expanded Bronze with Atrium Health Tier 2 - Generic — — — None
Standard Silver with Atrium Health Tier 2 - Generic — — — None
Standard Gold with Atrium Health Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 2 - Generic — — — None
Complete Gold + Vision + Adult Dental Tier 2 - Generic — — — None
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic — — — None
Elite Bronze + Vision + Adult Dental Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Standard Expanded Bronze + Vision + Adult Dental Tier 2 - Generic — — — None
Standard Silver + Vision + Adult Dental Tier 2 - Generic — — — None
Complete Gold
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 1 hour, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026
via lamotrigine 		Tier 1 - Generic — — — None
BCBS Federal Focus 2026
via lamotrigine 		Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026
via lamotrigine 		Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026
via Lamictal Xr 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Lamictal Xr 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Standard Option 2026
via Lamictal 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Basic Option 2026
via Lamictal 		Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 1 hour, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026
via Lamictal 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Lamictal 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Advantage 2026
via Lamictal 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Lamictal 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Lamictal 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Value 2026
via Lamictal Chewable Di 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Care 2026
via Lamictal Chewable Di 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Advantage 2026
via Lamictal Chewable Di 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Lamictal Chewable Di 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Local 2026
via Lamictal Chewable Di 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Care 2026
via Lamictal Xr 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Value 2026
via Lamictal Xr 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Local 2026
via Lamictal Xr 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Home with UNC Health Alliance 2026
via Lamictal Xr 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Advantage 2026
via Lamictal Xr 		Tier 2 - Medium Cost Generic/Brand — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 1 hour, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026 Tier 1 - Generic — — — None
Cigna Plus NC 4-Tier Formulary 2026
via lamotrigine 		Tier 2 - Preferred Brand — — — None
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 1 hour, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Liberty Medicare Dual Plan (HMO D-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 2160 per 30 days PA | QL
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic ✓ — ✓ 2160 per 30 days PA | QL
Longevity Health Plan (HMO I-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 2160 per 30 days PA | QL
NHC Advantage (HMO I-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 2160 per 30 days PA | QL
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
HealthSpring TotalCare (HMO D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Wellcare Dual Reserve (HMO-POS D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Wellcare Dual Liberty (HMO-POS D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Wellcare Dual Access (HMO-POS D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Wellcare Assist Open (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Wellcare Dual Liberty Open (PPO D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
AmeriHealth Caritas VIP Care (HMO D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Troy Medicare (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Dual (HMO D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Signature (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Value Plus (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Prime (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Signature Care (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Full Dual Care (HMO D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Enhanced (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Signature Extra (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Signature Giveback (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Signature (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Senior Care (HMO I-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Chronic Care (HMO C-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Wellcare Simple Open (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Liberty Medicare Advantage (HMO C-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring True Choice (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Wellcare Giveback Open (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Wellcare Simple (HMO-POS)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring Preferred (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring Preferred Select (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring Preferred Savings (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring Preferred Plus (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
Erickson Advantage Liberty (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S001 (PPO D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum Select (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health AVA (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Healthy Blue + Medicare (HMO-POS D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Experience Health Medicare Advantage (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED CORE 001 NC (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 002 NC (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 012 NC (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 001 NC (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 003 NC (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 005 NC (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 008 NC (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Champion (HMO-POS C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health smartHMO (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health NC Duals (HMO-POS D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Blue Medicare Essential (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Blue Medicare Essential Plus (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Blue Medicare PPO Enhanced (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Blue Medicare Choice (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Blue Medicare Enhanced (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S2 (PPO D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Signature (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Guardian (HMO-POS I-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Freedom (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Senior Care (HMO I-SNP) Tier 4 - Non-Preferred ✓ — ✓ 2160 per 30 days PA | QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 4 - Non-Preferred — — — None
Erickson Advantage Signature (HMO-POS) Tier 4 - Non-Preferred — — — None
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 4 - Non-Preferred — — — None
Erickson Advantage Freedom (HMO-POS) Tier 4 - Non-Preferred — — — None
Erickson Advantage Liberty (HMO-POS) Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
Erickson Advantage Champion (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Dual (HMO D-SNP) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Value Plus (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Prime (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature Care (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Enhanced (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature Extra (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature Giveback (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Chronic Care (HMO C-SNP) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred ✓ — — PA
Liberty Medicare Advantage (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 2160 per 30 days PA | QL
HealthTeam Advantage Plan I (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan II (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Vitality Plan (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan I (PPO) Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Plan II (PPO) Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Vitality Plan (PPO) Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-137 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-233 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Dual Select H1036-307 (HMO D-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-335 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HumanaChoice Giveback H5216-017 (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5216-211 (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Full Access H5525-034 (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HumanaChoice Giveback H5525-035 (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-049 (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-050 (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-070 (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Dual Select H5525-072 (PPO D-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-083 (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-025 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-026 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-057 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-060 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-061 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Choice H8145-004 (PFFS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-137 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-233 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Dual Select H1036-307 (HMO D-SNP) Tier 4 - Non-Preferred — — — None
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-335 (HMO-POS) Tier 4 - Non-Preferred — — — None
HumanaChoice Giveback H5216-017 (PPO) Tier 4 - Non-Preferred — — — None
HumanaChoice H5216-211 (PPO) Tier 4 - Non-Preferred — — — None
Humana Full Access H5525-034 (PPO) Tier 4 - Non-Preferred — — — None
HumanaChoice Giveback H5525-035 (PPO) Tier 4 - Non-Preferred — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-049 (PPO) Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-050 (PPO) Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-070 (PPO) Tier 4 - Non-Preferred — — — None
Humana Dual Select H5525-072 (PPO D-SNP) Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-083 (PPO) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-025 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-026 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-057 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-060 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-061 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Choice H8145-004 (PFFS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 4 - Non-Preferred — — — None
DEVOTED GIVEBACK 012 NC (HMO) Tier 5 - Specialty — ✓ — ST
HealthSpring Preferred Select (HMO) Tier 5 - Specialty — — — None
Blue Medicare PPO Enhanced (PPO) Tier 5 - Specialty — — — None
Blue Medicare Essential Plus (HMO-POS) Tier 5 - Specialty — — — None
Blue Medicare Enhanced (HMO-POS) Tier 5 - Specialty — — — None
Blue Medicare Choice (HMO) Tier 5 - Specialty — — — None
Blue Medicare Essential (HMO) Tier 5 - Specialty — — — None
Experience Health Medicare Advantage (HMO) Tier 5 - Specialty — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 5 - Specialty — — — None
HealthSpring Preferred (HMO) Tier 5 - Specialty — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 5 - Specialty — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 5 - Specialty — — — None
HealthSpring True Choice (PPO) Tier 5 - Specialty — — — None
Alignment Health Platinum (HMO) Tier 5 - Specialty — — — None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 5 - Specialty — — — None
Alignment Health smartHMO (HMO) Tier 5 - Specialty — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 5 - Specialty — — — None
Alignment Health Platinum Select (HMO) Tier 5 - Specialty — — — None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 5 - Specialty — — — None
Alignment Health AVA (PPO) Tier 5 - Specialty — — — None
Wellcare Dual Liberty Open (PPO D-SNP) Tier 5 - Specialty — — — None
Wellcare Assist Open (PPO) Tier 5 - Specialty — — — None
Wellcare Dual Access (HMO-POS D-SNP) Tier 5 - Specialty — — — None
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 5 - Specialty — — — None
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE 008 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE 005 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE 003 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE 001 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED GIVEBACK 002 NC (HMO) Tier 5 - Specialty — ✓ — ST
DEVOTED CORE 001 NC (HMO) Tier 5 - Specialty — ✓ — ST
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 5 - Specialty — ✓ — ST
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 5 - Specialty — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 5 - Specialty — ✓ — ST
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 5 - Specialty — ✓ — ST
Wellcare Simple Open (PPO) Tier 5 - Specialty — — — None
Wellcare Simple (HMO-POS) Tier 5 - Specialty — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 5 - Specialty — ✓ — ST
Wellcare Giveback Open (PPO) Tier 5 - Specialty — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 5 - Specialty — ✓ — ST
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 5 - Specialty — ✓ — ST
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 5 - Specialty — ✓ — ST
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 5 - Specialty — ✓ — ST
HealthSpring Preferred Plus (HMO) Tier 5 - Specialty — — — None
HealthSpring Preferred Savings (HMO) Tier 5 - Specialty — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 1 hour, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via lamotrigine 		Preferred — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 1 hour, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via lamotrigine 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via lamotrigine 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - HDHP 2026 Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via lamotrigine 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Lamictal 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Lamictal 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Lamictal 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Lamictal Xr 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via lamotrigine tb24 		Not Covered — — — (applies to NDC None
NC State Health Plan - 70/30 Standard PPO 2026
via lamotrigine tb24 		Not Covered — — — (applies to NDC None
NC State Health Plan - 80/20 Plus PPO 2026
via lamotrigine tb24 		Not Covered — — — (applies to NDC None
NC State Health Plan - 70/30 Standard PPO 2026
via Lamictal Xr 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Lamictal Xr 		Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 1 hour, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via lamotrigine 		Tier 3 - Non-Formulary — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 1 hour, 31 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026
via lamotrigine 		Tier 2 - Lower Cost — — — None
UnitedHealthcare NC Individual & Family 2026 Tier 2 - Lower Cost — — — None
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