Alyglo

Generic: immunoglobulin G

5G — Solution

Also known as: ALYGLO SOLN 5GM/50ML, 10GM/100ML, 20GM/200ML ALYGLO SOLN 5GM/50ML, 10GM/100ML,

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

10 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 18 hours, 58 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026 via Cuvitru	Tier 2 - Preferred Brand	✓	—	—	PA
BCBS Federal Focus 2026 via Hizentra	Tier 2 - Preferred Brand	✓	—	—	PA
BCBS Federal Standard Option 2026 via Hizentra	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026 via Hizentra	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026 via Cuvitru	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026 via Cutaquig	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026 via Cutaquig	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026 via Cuvitru	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

12 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 18 hours, 58 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Hizentra	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026 via Cutaquig	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026 via Cutaquig	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - HDHP 2026 via Cutaquig	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026 via Hizentra	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026 via Hizentra	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026 via Cuvitru	Medical Benefit	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Cuvitru	Medical Benefit	—	—	—	None
NC State Health Plan - HDHP 2026 via Cuvitru	Medical Benefit	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026	Not Covered	—	—	—	None