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 SUBVENITE SUSP 10MG/ML 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 SUBVENITE TAB START KIT(GREEN) SUBVENITE TAB START KT(ORANGE) SUBVENITE TAB START KIT (BLUE)
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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: 14 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Elite Bronze + Vision + Adult Dental Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Elite Bronze
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Everyday Bronze
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Complete Gold
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Standard Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic — — — None
Standard Expanded Bronze
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
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
Standard Gold + Vision + Adult Dental Tier 2 - Generic — — — None
Standard Gold with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Silver with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Expanded Bronze with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Complete Gold with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Focused Silver with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Elite Bronze with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Everyday Bronze with Atrium Health
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Gold
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Standard Silver
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
Complete Gold 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
Elite Bronze with Atrium Health + 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 + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Everyday Bronze + Vision + Adult Dental
via lamotrigine 		Tier 2 - Generic — — ✓ QL
Complete Gold + 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
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
Source: CMS QHP JSON  ·  Checked: 14 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Premier + No Referrals
via lamotrigine 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Signature + No Referrals
via lamotrigine 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals
via lamotrigine 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Signature + No Referrals
via lamotrigine 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Essential + No Referrals
via lamotrigine 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Premier + No Referrals
via lamotrigine 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + No Referrals
via lamotrigine 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via lamotrigine 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via lamotrigine 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + No Referrals
via lamotrigine 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 14 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026
via lamotrigine 		Tier 1 - Generic — — — None
BCBS Federal Standard Option 2026
via lamotrigine 		Tier 1 - Generic — — — None
BCBS Federal Focus 2026
via lamotrigine 		Tier 1 - Generic — — — None
BCBS Federal Basic Option 2026
via Lamictal 		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 Standard Option 2026
via Lamictal Xr 		Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Standard Option 2026 Tier 3 - Non-Preferred Brand — — — None
BCBS Federal Basic Option 2026 Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 14 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026
via Lamictal 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Local 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 Advantage 2026
via Lamictal 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Care 2026
via Lamictal 		Tier 1 - Lowest Cost Generic — — — None
BCBSNC Blue Home with UNC Health Alliance 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 Value 2026
via Lamictal Xr 		Tier 2 - Medium Cost Generic/Brand — — — None
BCBSNC Blue Care 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
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 Local 2026
via Lamictal Chewable Di 		Tier 2 - Medium Cost Generic/Brand — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 14 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze RD 6000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze 5500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect myDiabetesCare Bronze Tier 2 - Generic — — — None
Connect Gold 1500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect Silver 4400 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect Silver 3000 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect Bronze 6500 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect Silver CMS Standard Tier 2 - Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect Gold CMS Standard Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard Tier 2 - Generic — — — None
Connect Gold RD CMS Standard Tier 2 - Generic — — — None
Connect Bronze CMS Standard Tier 2 - Generic — — — None
Connect Silver CMS Standard
via lamotrigine 		Tier 2 - Generic — — — None
Connect Silver RD CMS Standard
via lamotrigine 		Tier 2 - Generic — — — None
Connect Gold CMS Standard
via lamotrigine 		Tier 2 - Generic — — — None
Connect Bronze RD CMS Standard
via lamotrigine 		Tier 2 - Generic — — — None
Connect Gold RD CMS Standard
via lamotrigine 		Tier 2 - Generic — — — None
Connect Bronze CMS Standard
via lamotrigine 		Tier 2 - Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible Tier 2 - Generic — — — None
Connect myDiabetesCare Silver Tier 2 - Generic — — — None
Connect Bronze 6500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 3000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 4400 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Bronze 7000 HSA Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD CMS Standard Tier 2 - Generic — — — None
Connect Silver 3500 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect Bronze 5500 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect myDiabetesCare Bronze
via lamotrigine 		Tier 2 - Generic — — — None
Connect Gold 1500 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect Silver RD 2200 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Connect myDiabetesCare Silver
via lamotrigine 		Tier 2 - Generic — — — None
Connect Bronze RD 5000 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver 3500 Indiv Med Deductible Tier 2 - Generic — — — None
Connect Silver RD 3500 Indiv Med Deductible
via lamotrigine 		Tier 2 - Generic — — — None
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 14 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Community Plan (HMO I-SNP) 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 Advantage Plan (HMO I-SNP)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic ✓ — ✓ 2160 per 30 days PA | QL
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)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home 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
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 Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Wellcare Simple Open (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Liberty Medicare Advantage (HMO C-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
Senior Care (HMO I-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring Preferred Plus (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring Preferred Savings (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring Preferred Select (HMO)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring Preferred (HMO)
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
HealthSpring True Choice (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via lamotrigine 		Tier 2 - Generic — — — None
HealthSpring TotalCare (HMO 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
Wellcare Giveback Open (PPO)
via lamotrigine 		Tier 2 - Generic — — — None
Wellcare Simple (HMO-POS)
via lamotrigine 		Tier 2 - Generic — — — None
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Dual Complete NC-S001 (PPO D-SNP)
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 Access from UHC NC-23 (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0001 (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-0016 (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
AARP Medicare Advantage from UHC NC-0017 (PPO)
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-0021 (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
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
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-0008 (HMO-POS)
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
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
Erickson Advantage Liberty (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
UHC Complete Care NC-25 (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
UHC Complete Care NC-28 (HMO-POS C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Erickson Advantage Champion (HMO-POS C-SNP)
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
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP)
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
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
Blue Medicare PPO Enhanced (PPO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Blue Medicare Essential Plus (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Blue Medicare Enhanced (HMO-POS)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Blue Medicare Choice (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Blue Medicare Essential (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Experience Health Medicare Advantage (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Healthy Blue + Medicare (HMO-POS D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health NC Duals (HMO-POS D-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health smartHMO (HMO)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via lamotrigine 		Tier 3 - Preferred Brand — — — None
Alignment Health Platinum Select (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
Aetna Medicare Value Plus (HMO) Tier 4 - Non-Preferred ✓ — — PA
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-060 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-057 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-026 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-025 (HMO-POS) Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-083 (PPO) Tier 4 - Non-Preferred — — — None
Humana Dual Select H5525-072 (PPO D-SNP) Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-070 (PPO) Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-050 (PPO) Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-049 (PPO) Tier 4 - Non-Preferred — — — None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 4 - Non-Preferred — — — None
HumanaChoice Giveback H5525-035 (PPO) Tier 4 - Non-Preferred — — — None
Humana Full Access H5525-034 (PPO) Tier 4 - Non-Preferred — — — None
HumanaChoice H5216-211 (PPO) Tier 4 - Non-Preferred — — — None
HumanaChoice Giveback H5216-017 (PPO) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-335 (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 Giveback H1036-318 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Dual Select H1036-307 (HMO D-SNP) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H1036-233 (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 H1036-137 (HMO-POS) Tier 4 - Non-Preferred — — — None
Humana Gold Choice H8145-004 (PFFS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-061 (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 H6622-057 (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 H6622-026 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-025 (HMO-POS)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-083 (PPO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Dual Select H5525-072 (PPO D-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HumanaChoice H5525-070 (PPO)
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
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
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
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
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 4 - Non-Preferred — — — None
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred ✓ — — PA
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
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Chronic Care (HMO C-SNP) Tier 4 - Non-Preferred ✓ — — PA
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Enhanced (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 4 - Non-Preferred ✓ — — PA
AARP Medicare Advantage from UHC NC-0017 (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-0004 (PPO) Tier 4 - Non-Preferred — — — None
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)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 4 - Non-Preferred — — — None
Troy Medicare (HMO)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 4 - Non-Preferred — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred ✓ — — PA
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
Senior Care (HMO I-SNP) Tier 4 - Non-Preferred ✓ — ✓ 2160 per 30 days PA | QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 4 - Non-Preferred — — — None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via lamotrigine 		Tier 4 - Non-Preferred — — — None
Humana Gold Choice H8145-004 (PFFS) Tier 4 - Non-Preferred — — — None
Humana Gold Plus H6622-061 (HMO-POS) Tier 4 - Non-Preferred — — — None
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 4 - Non-Preferred — — — None
Liberty Medicare Advantage (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 2160 per 30 days PA | QL
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 4 - Non-Preferred — — — None
Erickson Advantage Champion (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 4 - Non-Preferred — — — None
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 4 - Non-Preferred — — — None
Aetna Medicare Signature Care (HMO) Tier 4 - Non-Preferred ✓ — — PA
Aetna Medicare Prime (HMO) Tier 4 - Non-Preferred ✓ — — PA
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 4 - Non-Preferred — — — None
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 5 - Specialty — — — None
DEVOTED CORE 001 NC (HMO) Tier 5 - Specialty — ✓ — ST
DEVOTED GIVEBACK 002 NC (HMO) Tier 5 - Specialty — ✓ — ST
DEVOTED GIVEBACK 012 NC (HMO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE 001 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE 003 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE 005 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE 008 NC (PPO) Tier 5 - Specialty — ✓ — ST
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 5 - Specialty — ✓ — ST
Aetna Medicare Signature (PPO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Signature Giveback (PPO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Signature (PPO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Signature (PPO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Signature Extra (PPO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Enhanced (PPO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Enhanced (PPO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Signature (PPO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Enhanced (HMO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Full Dual Care (HMO D-SNP)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Signature Care (HMO)
via lamotrigine 		Tier 5 - Specialty — — — None
Wellcare Simple Open (PPO) Tier 5 - Specialty — — — None
Wellcare Simple (HMO-POS) Tier 5 - Specialty — — — None
Aetna Medicare Prime (HMO)
via lamotrigine 		Tier 5 - Specialty — — — None
Wellcare Giveback Open (PPO) 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
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
Aetna Medicare Value Plus (HMO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Signature (HMO)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Dual (HMO D-SNP)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Signature (HMO)
via lamotrigine 		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
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 5 - Specialty — — — None
HealthSpring True Choice (PPO) Tier 5 - Specialty — — — None
HealthSpring TotalCare (HMO D-SNP) Tier 5 - Specialty — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 5 - Specialty — — — None
Aetna Medicare Chronic Care Value (HMO C-SNP)
via lamotrigine 		Tier 5 - Specialty — — — None
Aetna Medicare Chronic Care (HMO C-SNP)
via lamotrigine 		Tier 5 - Specialty — — — None
HealthSpring Preferred (HMO) Tier 5 - Specialty — — — None
HealthSpring Preferred Select (HMO) Tier 5 - Specialty — — — None
HealthSpring Preferred Savings (HMO) Tier 5 - Specialty — — — None
HealthSpring Preferred Plus (HMO) Tier 5 - Specialty — — — None
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 5 - Specialty — ✓ — ST
DEVOTED C-SNP PREMIUM 014 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 016 NC (HMO C-SNP) Tier 5 - Specialty — ✓ — ST
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 5 - Specialty — ✓ — ST
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 5 - Specialty — ✓ — ST
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 5 - Specialty — ✓ — ST
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 5 - Specialty — ✓ — ST
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 14 hours, 46 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: Jul 1, 2026  ·  Checked: 14 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - HDHP 2026 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 - 70/30 Standard PPO 2026
via lamotrigine 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - HDHP 2026
via lamotrigine 		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 - 80/20 Plus PPO 2026
via Lamictal 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Lamictal 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Lamictal 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via lamotrigine tb24 		Not Covered — — — (applies to NDC None
NC State Health Plan - HDHP 2026
via lamotrigine tb24 		Not Covered — — — (applies to NDC None
NC State Health Plan - 80/20 Plus PPO 2026
via Lamictal Xr 		Not Covered — — — None
NC State Health Plan - 70/30 Standard 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 - HDHP 2026
via Lamictal Xr 		Not Covered — — — None
Source: CMS QHP JSON  ·  Checked: 14 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Gold Classic Standard
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Bronze Classic 4700
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Secure
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Classic
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Bronze Elite + PCP Saver Plus
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Gold Classic Standard | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Classic Standard | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Bronze Classic Standard | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Simple PCP Saver
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Classic Standard
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Bronze Classic Standard
via lamotrigine 		Tier 2 - Generic ✓ — — PA
AIAN Cost Share | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
AIAN Cost Share
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Simple Chronic Care CKM | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Bronze Simple Diabetes | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Bronze Simple Chronic Care CKM | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Gold Elite Saver Plus | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Simple PCP Saver | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Simple Diabetes | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Classic | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Bronze Elite + PCP Saver Plus | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Bronze Classic 4700 | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Secure | with Atrium Health
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Silver Simple Diabetes
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Gold Elite Saver Plus
via lamotrigine 		Tier 2 - Generic ✓ — — PA
Source: Excel (XLSX)  ·  Formulary date: Jun 24, 2026  ·  Checked: 14 hours, 46 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: Jun 23, 2026  ·  Checked: 14 hours, 46 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 1 - Preferred Generic — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Silver Standard (No Referrals) Tier 1 - Preferred Generic — — — None
UHC Gold Standard (No Referrals) Tier 1 - Preferred Generic — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 1 - Preferred Generic — — — None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Gold Standard (No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Bronze Standard (No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Bronze Standard+ Dental + Vision (No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Bronze Standard (No Referrals) Tier 1 - Preferred Generic — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 1 - Preferred Generic — — — None
UHC Silver Standard (No Referrals)
via lamotrigine 		Tier 1 - Preferred Generic — — — None
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