Blujepa

Generic: gepotidacin

750 MG — Tablet

Triazaacenaphthylene Bacterial Type II Topoisomerase Inhibitor

Also known as: gepotidacin BLUJEPA TABS 750MG
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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.
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 15 hours, 54 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 3 - Preferred Brand — — — None
Aetna Medicare Dual (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Signature (HMO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Value Plus (HMO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Prime (HMO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Signature Care (HMO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Enhanced (HMO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Signature (PPO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Enhanced (PPO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Enhanced (PPO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Signature Extra (PPO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Signature (PPO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Signature (PPO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Signature Giveback (PPO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Signature (PPO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 008 NC (PPO) Tier 3 - Preferred Brand — — — None
Aetna Medicare Signature (HMO) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Chronic Care (HMO C-SNP) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 3 - Preferred Brand — — ✓ 20 per 5 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 3 - Preferred Brand — — — None
DEVOTED CORE 001 NC (HMO) Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 002 NC (HMO) Tier 3 - Preferred Brand — — — None
DEVOTED GIVEBACK 012 NC (HMO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 001 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 003 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 3 - Preferred Brand — — — None
DEVOTED CHOICE 005 NC (PPO) Tier 3 - Preferred Brand — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 15 hours, 54 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 3 - Non-Preferred Brand ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026 Tier 3 - Non-Preferred Brand ✓ — — PA
NC State Health Plan - HDHP 2026 Tier 3 - Non-Preferred Brand ✓ — — PA
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