Adbry

Generic: tralokinumab-ldrm

150 MG, 300 MG — Prefilled Syringe

Also known as: tralokinumab-ldrm ADBRY SOAJ 300MG/2ML; SOSY 150MG/ML

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 6 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 6 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Local 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access; Limited Distribution	PA \| QL
BCBSNC Blue Value 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access; Limited Distribution	PA \| QL
BCBSNC Blue Advantage 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access; Limited Distribution	PA \| QL
BCBSNC Blue Care 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access; Limited Distribution	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access; Limited Distribution	PA \| QL

8 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 6 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Provider Partners North Carolina Essential Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 8 per 28 days	PA \| QL
Longevity Health Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 6 per 28 days	PA \| QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 8 per 28 days	PA \| QL
Provider Partners North Carolina Community Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 8 per 28 days	PA \| QL
HealthTeam Advantage Vitality Plan (PPO)	Tier 5 - Specialty	✓	—	✓ 8 per 28 days	PA \| QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 8 per 28 days	PA \| QL
HealthTeam Advantage Plan I (PPO)	Tier 5 - Specialty	✓	—	✓ 8 per 28 days	PA \| QL
HealthTeam Advantage Plan II (PPO)	Tier 5 - Specialty	✓	—	✓ 8 per 28 days	PA \| QL

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 6 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via tralokinumab-ldrm	Tier 3 - Non-Formulary	✓	—	✓	PA \| QL