Tonmya
Generic: cyclobenzaprine HCl
2.8 MG — Sublingual Tablet
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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.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via cyclobenzaprine hcl |
Tier 2 - Generic | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via cyclobenzaprine hcl |
Tier 2 - Generic | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via cyclobenzaprine hcl |
Tier 2 - Generic | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via cyclobenzaprine hcl |
Tier 2 - Generic | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via cyclobenzaprine hcl |
Tier 2 - Generic | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via cyclobenzaprine hcl |
Tier 2 - Generic | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via cyclobenzaprine hcl |
Tier 2 - Generic | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via cyclobenzaprine hcl |
Tier 2 - Generic | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via cyclobenzaprine hcl |
Tier 2 - Generic | — | — | ✓ | QL |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via cyclobenzaprine hcl |
Tier 2 - Generic | — | — | ✓ | QL |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via cyclobenzaprine hcl |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Standard Option 2026
via cyclobenzaprine hcl |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via cyclobenzaprine hcl |
Tier 1 - Generic | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Local 2026
via cyclobenzaprine hcl |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Care 2026
via cyclobenzaprine hcl |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Value 2026
via cyclobenzaprine hcl |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via cyclobenzaprine hcl |
Tier 1 - Lowest Cost Generic | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via cyclobenzaprine hcl |
Tier 1 - Lowest Cost Generic | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - HDHP 2026
via cyclobenzaprine hcl |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via cyclobenzaprine hcl |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via cyclobenzaprine hcl |
Tier 1 - Preferred Generic | — | — | — | None |
TRICARE
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
TRICARE Uniform Formulary 2026
via cyclobenzaprine hcl |
Tier 1 - Generic Formulary (Basic Core) | ✓ | — | ✓ AMRIX 15MG TO BE DISP AT MAX QTY OF 42 CAPSULES IN 15 DAYS OR 42 CAPSULES IN 16 DAYS | PA | QL PA on 157 of 491 NDCs: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED; Quantity limit on 44 of 491 NDCs |
| TRICARE Uniform Formulary 2026 | Tier 3 - Non-Formulary | ✓ | — | ✓ TONMYA SUBLINGUAL TABLET, SUBLINGUAL TO BE DISPENSED AT A MAXIMUM QUANTITY OF 60 TABLETS IN 23 DAYS | PA | QL PA: TPA - SELECT DRUGS REQUIRES PRIOR AUTHORIZATION (NEW TO MARKET DRUGS); Quantity limit |