Symbyax

Generic: Olanzapine-Fluoxetine

25MG — Capsule

Serotonin Reuptake Inhibitor

Also known as: SYMBYAX CAP 3-25MG SYMBYAX CAP 6-25MG
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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: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 14 hours, 4 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 7000 HSA Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Bronze RD CMS Standard
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 3500 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 5000 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Silver RD CMS Standard
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Silver RD 2200 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Gold RD CMS Standard
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Bronze 6500 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Bronze 5500 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Silver 5000 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Silver 3600 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Silver 3000 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Bronze CMS Standard
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Silver CMS Standard
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Gold CMS Standard
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect myDiabetesCare Bronze
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect myDiabetesCare Silver
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Connect Gold 1500 Indiv Med Deductible
via Olanzapine-Fluoxetine 		Tier 3 - Preferred Brand — — — None
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 14 hours, 4 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
HealthSpring True Choice (PPO)
via Olanzapine-Fluoxetine 		Tier 4 - Non-Preferred — — — None
HealthSpring TotalCare (HMO D-SNP)
via Olanzapine-Fluoxetine 		Tier 4 - Non-Preferred — — — None
HealthSpring Preferred (HMO)
via Olanzapine-Fluoxetine 		Tier 4 - Non-Preferred — — — None
HealthSpring TotalCare Plus (HMO D-SNP)
via Olanzapine-Fluoxetine 		Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Select (HMO)
via Olanzapine-Fluoxetine 		Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Savings (HMO)
via Olanzapine-Fluoxetine 		Tier 4 - Non-Preferred — — — None
HealthSpring Preferred Plus (HMO)
via Olanzapine-Fluoxetine 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 14 hours, 4 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Olanzapine-Fluoxetine 		Non-Preferred — ✓ — ST
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