Afstyla

Generic: lonoctocog alfa

250UNIT, 500UNIT, 1000UNIT, 1500UNIT, 2000UNIT, 2500UNIT, 3000UNIT — Kit

HEMATOLOGICAL AGENTS - MISC.

Also known as: AFSTYLA KIT 250UNIT, 500UNIT, 1000UNIT, 1500UNIT, 2000UNIT, 2500UNIT, 3000UNIT lonoctocog alfa AFSTYLA KIT 250UNIT, 500UNIT, 1000UNIT,

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  ·  Formulary date: Jan 1, 2026  ·  Checked: 14 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Signature Gold Tier 5 - Specialty ✓ — — PA
Signature Silver + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Signature Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Signature Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Signature Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Focused Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Complete Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Complete Gold Tier 5 - Specialty ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options Tier 5 - Specialty ✓ — — PA
Everyday Bronze Tier 5 - Specialty ✓ — — PA
Elite Bronze Tier 5 - Specialty ✓ — — PA
Enhanced CHF Heart Care Silver $0 Rx Options Tier 5 - Specialty ✓ — — PA
Streamlined Silver with Atrium Health Tier 5 - Specialty ✓ — — PA
Streamlined Silver Tier 5 - Specialty ✓ — — PA
Clear Silver with $0 Insulin Options + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Clear Silver with $0 Insulin Options Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze Tier 5 - Specialty ✓ — — PA
Signature Silver Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Everyday Bronze with Atrium Health Tier 5 - Specialty ✓ — — PA
Elite Bronze with Atrium Health Tier 5 - Specialty ✓ — — PA
Focused Silver with Atrium Health Tier 5 - Specialty ✓ — — PA
Complete Gold with Atrium Health Tier 5 - Specialty ✓ — — PA
Signature Expanded Bronze with Atrium Health Tier 5 - Specialty ✓ — — PA
Signature Silver with Atrium Health Tier 5 - Specialty ✓ — — PA
Signature Gold with Atrium Health Tier 5 - Specialty ✓ — — PA
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Complete Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Everyday Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Elite Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 14 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026 Tier 2 - Preferred Brand — — — None
BCBS Federal Standard Option 2026 Tier 4 - Preferred Specialty — — — None
BCBS Federal Basic Option 2026 Tier 4 - Preferred Specialty — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 14 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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 Home with UNC Health Alliance 2026 Tier 5 - Specialty ✓ — ✓ Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Local 2026 Tier 5 - Specialty ✓ — ✓ Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Care 2026 Tier 5 - Specialty ✓ — ✓ Restricted Access; Limited Distribution PA | QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 14 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 5 - Preferred Brand Specialty ✓ — — PA
NC State Health Plan - HDHP 2026 Tier 5 - Preferred Brand Specialty ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026 Tier 5 - Preferred Brand Specialty ✓ — — PA
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