suzetrigine

Generic: Journavx

50 mg — Tablet

PAIN AGENTS

Also known as: JOURNAVX
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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  ·  Checked: 8 hours, 54 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Journavx 		Brand-Preferred ✓ — ✓ PA | QL
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Journavx 		Brand-Preferred ✓ — ✓ PA | QL
AmeriHealth Caritas Next Gold Signature + No Referrals
via Journavx 		Brand-Preferred ✓ — ✓ PA | QL
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Journavx 		Brand-Preferred ✓ — ✓ PA | QL
AmeriHealth Caritas Next Gold Premier + No Referrals
via Journavx 		Brand-Preferred ✓ — ✓ PA | QL
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Journavx 		Brand-Preferred ✓ — ✓ PA | QL
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Journavx 		Brand-Preferred ✓ — ✓ PA | QL
AmeriHealth Caritas Next Silver Essential + No Referrals
via Journavx 		Brand-Preferred ✓ — ✓ PA | QL
AmeriHealth Caritas Next Silver Signature + No Referrals
via Journavx 		Brand-Preferred ✓ — ✓ PA | QL
AmeriHealth Caritas Next Silver Premier + No Referrals
via Journavx 		Brand-Preferred ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 8 hours, 54 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via Journavx 		Tier 2 - Preferred Brand — — ✓ QL
BCBS Federal Standard Option 2026
via Journavx 		Tier 3 - Non-Preferred Brand — — ✓ QL
BCBS Federal Basic Option 2026
via Journavx 		Tier 3 - Non-Preferred Brand — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 8 hours, 54 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP)
via Journavx 		Tier 1 - Preferred Generic — — ✓ 30 per 90 days QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Journavx 		Tier 1 - Preferred Generic — — ✓ 30 per 90 days QL
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Journavx 		Tier 1 - Preferred Generic — — ✓ 30 per 90 days QL
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Journavx 		Tier 1 - Preferred Generic — — ✓ 30 per 90 days QL
Wellcare Dual Access (HMO-POS D-SNP)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
Wellcare Simple Open (PPO)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
Wellcare Simple (HMO-POS)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
Wellcare Giveback Open (PPO)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
HealthTeam Advantage Plan I (PPO)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
HealthTeam Advantage Plan II (PPO)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
HealthTeam Advantage Vitality Plan (PPO)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
Wellcare Dual Liberty Open (PPO D-SNP)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
Wellcare Assist Open (PPO)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
Wellcare Dual Liberty (HMO-POS D-SNP)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
Wellcare Dual Reserve (HMO-POS D-SNP)
via Journavx 		Tier 4 - Non-Preferred — — ✓ 30 per 90 days QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 8 hours, 54 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Journavx 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Journavx 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Journavx 		Not Covered — — — None
Source: CMS QHP JSON  ·  Checked: 8 hours, 54 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Simple Diabetes
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Secure | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic 4700 | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Elite + PCP Saver Plus | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Diabetes | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple PCP Saver | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Gold Elite Saver Plus | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Chronic Care CKM | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Simple Diabetes | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Chronic Care CKM | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
AIAN Cost Share
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
AIAN Cost Share | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Secure
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Elite + PCP Saver Plus
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Gold Classic Standard | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic Standard | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic Standard | with Atrium Health
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Gold Classic Standard
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Silver Classic Standard
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic Standard
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Bronze Classic 4700
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Silver Simple PCP Saver
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Gold Elite Saver Plus
via Journavx 		Tier 3 - Preferred Brand — — ✓ QL
Source: Excel (XLSX)  ·  Formulary date: Jun 24, 2026  ·  Checked: 8 hours, 54 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary — — ✓ QL
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