Subvenite

Generic: lamotrigine

25mg, 100mg, 150mg, 200mg — Tablet

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.

Ambetter (Centene)

68 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 15 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Clear Silver with $0 Insulin Options	Tier 2 - Generic	—	—	—	None
Signature Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Signature Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Signature Gold + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Signature Silver + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Signature Expanded Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Elite Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Everyday Bronze + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Complete Gold + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Signature Gold with Atrium Health	Tier 2 - Generic	—	—	—	None
Signature Silver with Atrium Health	Tier 2 - Generic	—	—	—	None
Signature Expanded Bronze with Atrium Health	Tier 2 - Generic	—	—	—	None
Complete Gold with Atrium Health	Tier 2 - Generic	—	—	—	None
Focused Silver with Atrium Health	Tier 2 - Generic	—	—	—	None
Elite Bronze with Atrium Health	Tier 2 - Generic	—	—	—	None
Everyday Bronze with Atrium Health	Tier 2 - Generic	—	—	—	None
Signature Gold	Tier 2 - Generic	—	—	—	None
Signature Silver	Tier 2 - Generic	—	—	—	None
Signature Expanded Bronze	Tier 2 - Generic	—	—	—	None
Elite Bronze	Tier 2 - Generic	—	—	—	None
Everyday Bronze	Tier 2 - Generic	—	—	—	None
Enhanced Asthma/COPD Care Silver $0 Rx Options	Tier 2 - Generic	—	—	—	None
Complete Gold	Tier 2 - Generic	—	—	—	None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Streamlined Silver via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Streamlined Silver with Atrium Health via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature Expanded Bronze with Atrium Health via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature Silver with Atrium Health via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature Gold with Atrium Health via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Streamlined Silver	Tier 2 - Generic	—	—	—	None
Streamlined Silver with Atrium Health	Tier 2 - Generic	—	—	—	None
Enhanced CHF Heart Care Silver $0 Rx Options	Tier 2 - Generic	—	—	—	None
Enhanced Asthma/COPD Care Silver $0 Rx 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 with Atrium Health + Vision + Adult Dental via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature Silver + Vision + Adult Dental via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature Gold + Vision + Adult Dental via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx 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
Signature Expanded Bronze via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature Silver via lamotrigine	Tier 2 - Generic	—	—	✓	QL
Signature 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
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental	Tier 2 - Generic	—	—	—	None
Complete Gold 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

AmeriHealth Caritas NC

11 plans

Source: CMS QHP JSON · Formulary date: Sep 22, 2026 · Checked: 15 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Silver Premier + No Referrals via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via lamotrigine	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals via lamotrigine	Tier 2 - Generic	—	—	—	None

Blue Cross Blue Shield Federal

9 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 15 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026 via lamotrigine	Tier 1 - Generic	—	—	—	None
BCBS Federal Basic Option 2026 via lamotrigine	Tier 1 - Generic	—	—	—	None
BCBS Federal Standard Option 2026 via lamotrigine	Tier 1 - Generic	—	—	—	None
BCBS Federal Basic 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 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	Tier 3 - Non-Preferred Brand	—	—	—	None
BCBS Federal Basic Option 2026	Tier 3 - Non-Preferred Brand	—	—	—	None

Blue Cross Blue Shield of NC

15 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 15 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026 via Lamictal	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Value 2026 via Lamictal	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Care 2026 via Lamictal	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Local 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 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 Advantage 2026 via Lamictal Xr	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 Advantage 2026 via Lamictal Chewable Di	Tier 2 - Medium Cost Generic/Brand	—	—	—	None
BCBSNC Blue Local 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 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 Home with UNC Health Alliance 2026 via Lamictal Xr	Tier 2 - Medium Cost Generic/Brand	—	—	—	None

Cigna

40 plans

Source: PDF · Formulary date: Oct 7, 2026 · Checked: 15 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Silver 3600 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze	Tier 2 - Generic	—	—	—	None
Connect Silver 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard	Tier 2 - Generic	—	—	—	None
Connect Silver 3600 Indiv Med Deductible	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None
Connect Silver 5000 Indiv Med Deductible via lamotrigine	Tier 2 - Generic	—	—	—	None

Medicare Part D

280 plans

Source: CMS QHP JSON · Formulary date: Sep 16, 2026 · Checked: 15 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Longevity Health Plan (HMO I-SNP) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
NHC Advantage (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 Community 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
Liberty Medicare Dual Plan (HMO D-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 2160 per 30 days	PA \| QL
NHC Advantage (HMO I-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
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
Provider Partners North Carolina Essential 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 Advantage Plan (HMO I-SNP)	Tier 1 - Preferred Generic	—	—	—	None
PruittHealth Premier (HMO I-SNP) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
Liberty Medicare Dual Plan (HMO D-SNP) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
Wellcare Dual Reserve (HMO-POS D-SNP) via lamotrigine	Tier 2 - Generic	—	—	—	None
Liberty Medicare Advantage (HMO C-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
Wellcare Simple Open (PPO) 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 TotalCare Plus (HMO D-SNP) via lamotrigine	Tier 2 - Generic	—	—	—	None
HealthSpring Preferred (HMO) via lamotrigine	Tier 2 - Generic	—	—	—	None
HealthSpring TotalCare (HMO D-SNP) via lamotrigine	Tier 2 - Generic	—	—	—	None
AmeriHealth Caritas VIP Care (HMO D-SNP) via lamotrigine	Tier 2 - Generic	—	—	—	None
HealthSpring True Choice (PPO) via lamotrigine	Tier 2 - Generic	—	—	—	None
Senior Care (HMO I-SNP) via lamotrigine	Tier 2 - Generic	—	—	—	None
Wellcare Simple (HMO-POS) via lamotrigine	Tier 2 - Generic	—	—	—	None
Wellcare Giveback Open (PPO) via lamotrigine	Tier 2 - Generic	—	—	—	None
Wellcare Dual Liberty (HMO-POS D-SNP) via lamotrigine	Tier 2 - Generic	—	—	—	None
Blue Medicare PPO Enhanced (PPO) 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
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
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
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
UHC Complete Care NC-25 (HMO-POS C-SNP) via lamotrigine	Tier 3 - Preferred Brand	—	—	—	None
AARP Medicare Advantage from UHC NC-26 (HMO-POS) 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
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
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 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 GIVEBACK 012 NC (HMO) 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
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 Champion (HMO-POS C-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
Alignment Health AVA (PPO) via lamotrigine	Tier 3 - Preferred Brand	—	—	—	None
Healthy Blue + Medicare (HMO-POS D-SNP) 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
Humana Dual Select H5525-072 (PPO D-SNP) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
UHC Nursing Home Plan NC-F001 (PPO I-SNP)	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 - Diabetes and Heart (HMO C-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
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
HealthTeam Advantage Diabetes & Heart Care (HMO 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 Chronic Care (HMO C-SNP)	Tier 4 - Non-Preferred	✓	—	—	PA
Aetna Medicare Enhanced (HMO)	Tier 4 - Non-Preferred	✓	—	—	PA
Aetna Medicare Chronic Care Value (HMO C-SNP)	Tier 4 - Non-Preferred	✓	—	—	PA
Senior Care (HMO I-SNP)	Tier 4 - Non-Preferred	✓	—	✓ 2160 per 30 days	PA \| QL
Troy Medicare (HMO)	Tier 4 - Non-Preferred	—	—	—	None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice Giveback H5216-017 (PPO)	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5216-211 (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
UHC Complete Care NC-25 (HMO-POS C-SNP)	Tier 4 - Non-Preferred	—	—	—	None
AARP Medicare Advantage from UHC NC-26 (HMO-POS)	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
HealthTeam Advantage Vitality Plan (PPO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
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
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
Erickson Advantage Signature (HMO-POS)	Tier 4 - Non-Preferred	—	—	—	None
Erickson Advantage Guardian (HMO-POS I-SNP)	Tier 4 - Non-Preferred	—	—	—	None
Erickson Advantage Champion (HMO-POS C-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
HealthTeam Advantage Plan II (PPO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Plan I (PPO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
Liberty Medicare Advantage (HMO C-SNP)	Tier 4 - Non-Preferred	✓	—	✓ 2160 per 30 days	PA \| QL
Humana Gold Choice H8145-004 (PFFS) via lamotrigine	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
AmeriHealth Caritas VIP Care (HMO D-SNP)	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
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
HumanaChoice H5525-070 (PPO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-050 (PPO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5525-049 (PPO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice Giveback H5525-035 (PPO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
Humana Full Access H5525-034 (PPO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice H5216-211 (PPO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
HumanaChoice Giveback H5216-017 (PPO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
Troy Medicare (HMO) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus H1036-335 (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 Giveback H1036-318 (HMO-POS) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	None
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) 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 H1036-233 (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 H1036-137 (HMO-POS) via lamotrigine	Tier 4 - Non-Preferred	—	—	—	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
DEVOTED CORE 001 NC (HMO)	Tier 5 - Specialty	—	✓	—	ST
DEVOTED GIVEBACK 002 NC (HMO)	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
DEVOTED GIVEBACK 012 NC (HMO)	Tier 5 - Specialty	—	✓	—	ST
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
Aetna Medicare Dual (HMO D-SNP) via lamotrigine	Tier 5 - Specialty	—	—	—	None
Aetna Medicare Signature (HMO) via lamotrigine	Tier 5 - Specialty	—	—	—	None
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
Wellcare Simple Open (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 Giveback Open (PPO)	Tier 5 - Specialty	—	—	—	None
Alignment Health AVA (PPO)	Tier 5 - Specialty	—	—	—	None
HealthSpring True Choice (PPO)	Tier 5 - Specialty	—	—	—	None
Healthy Blue + Medicare (HMO-POS D-SNP)	Tier 5 - Specialty	—	—	—	None
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
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
Wellcare Simple (HMO-POS)	Tier 5 - Specialty	—	—	—	None
Wellcare Dual Access (HMO-POS D-SNP)	Tier 5 - Specialty	—	—	—	None
Wellcare Dual Reserve (HMO-POS D-SNP)	Tier 5 - Specialty	—	—	—	None
Wellcare Dual Liberty (HMO-POS D-SNP)	Tier 5 - Specialty	—	—	—	None
DEVOTED CHOICE 008 NC (PPO)	Tier 5 - Specialty	—	✓	—	ST
DEVOTED CHOICE GIVEBACK 009 NC (PPO)	Tier 5 - Specialty	—	✓	—	ST
HealthSpring TotalCare (HMO D-SNP)	Tier 5 - Specialty	—	—	—	None
HealthSpring Preferred (HMO)	Tier 5 - Specialty	—	—	—	None
HealthSpring TotalCare Plus (HMO D-SNP)	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
Aetna Medicare Chronic Care Value (HMO C-SNP) via lamotrigine	Tier 5 - Specialty	—	—	—	None
Aetna Medicare Enhanced (HMO) via lamotrigine	Tier 5 - Specialty	—	—	—	None
Aetna Medicare Chronic Care (HMO C-SNP) 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
Aetna Medicare Prime (HMO) via lamotrigine	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

NC Medicaid PDL

2 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 15 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via lamotrigine	Preferred	—	—	—	None
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	—	—	None

NC State Health Plan

15 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 15 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
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	Tier 2 - Non-Preferred Generic	—	—	—	None
NC State Health Plan - HDHP 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 - HDHP 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 via Lamictal Xr	Not Covered	—	—	—	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 lamotrigine tb24	Not Covered	—	—	— (applies to NDC	None
NC State Health Plan - HDHP 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 - 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

Oscar Health

28 plans

Source: CMS QHP JSON · Checked: 15 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Bronze Elite + PCP Saver Plus \| with Atrium Health 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
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 Classic 4700 \| with Atrium Health via lamotrigine	Tier 2 - Generic	✓	—	—	PA
Secure \| 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 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
Gold Classic Standard via lamotrigine	Tier 2 - Generic	✓	—	—	PA
Silver Classic Standard via lamotrigine	Tier 2 - Generic	✓	—	—	PA
Bronze Classic Standard 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
Silver Simple PCP Saver 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

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jul 31, 2026 · Checked: 15 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via lamotrigine	Tier 3 - Non-Formulary	—	—	—	None

UnitedHealthcare

34 plans

Source: PDF · Formulary date: Sep 23, 2026 · Checked: 15 hours, 25 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, 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+ (HSA, $0 Insulin, Dental + Vision, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, 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 Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, 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 Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) via lamotrigine	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 Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) via lamotrigine	Tier 1 - Preferred Generic	—	—	—	None
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)	Tier 1 - Preferred Generic	—	—	—	None