Amjevita(CF)

Generic: adalimumab-atto

10MG/0.2ML, 20MG/0.2ML, 20MG/0.4ML, 40MG/0.4ML, 40MG/0.8ML, 80MG/0.8ML — Prefilled Syringe

Also known as: Amjevita(CF) Autoinjector

Coverage by Insurer

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

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Sep 23, 2026 · Checked: 9 hours, 1 minute ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED

UnitedHealthcare

17 plans

Source: PDF · Formulary date: Sep 23, 2026 · Checked: 9 hours, 1 minute ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) via Amjevita	Tier 5 - Specialty	✓	—	✓	PA \| QL