Cimzia Starter

Generic: certolizumab pegol

200MG — Kit

GASTROINTESTINAL AGENTS- MISC.

Also known as: Cimzia Starter Kit CIMZIA STARTER KIT PSKT 200MG/ML

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 13 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026
via Cimzia
Tier 5 - Non-Preferred Specialty PA
BCBS Federal Basic Option 2026 Tier 5 - Non-Preferred Specialty PA
BCBS Federal Standard Option 2026
via Cimzia
Tier 5 - Non-Preferred Specialty PA
BCBS Federal Standard Option 2026 Tier 5 - Non-Preferred Specialty PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 13 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Care 2026
via Cimzia
Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Value 2026
via Cimzia
Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Advantage 2026 Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Local 2026 Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Care 2026 Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Value 2026 Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Advantage 2026
via Cimzia
Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026
via Cimzia
Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Local 2026
via Cimzia
Tier 5 - Specialty Restricted Access PA | QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 13 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
PruittHealth Premier (HMO I-SNP)
via Cimzia
Tier 1 - Preferred Generic 3 per 28 days PA | QL
Liberty Medicare Dual Plan (HMO D-SNP)
via Cimzia
Tier 1 - Preferred Generic 3 per 28 days PA | QL
Longevity Health Plan (HMO I-SNP)
via Cimzia
Tier 1 - Preferred Generic 3 per 180 days PA | QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Cimzia
Tier 1 - Preferred Generic 3 per 28 days PA | QL
NHC Advantage (HMO I-SNP)
via Cimzia
Tier 1 - Preferred Generic 3 per 28 days PA | QL
Senior Care (HMO I-SNP)
via Cimzia
Tier 5 - Specialty 3 per 28 days PA | QL
Liberty Medicare Advantage (HMO C-SNP)
via Cimzia
Tier 5 - Specialty 3 per 28 days PA | QL
Troy Medicare (HMO)
via Cimzia
Tier 5 - Specialty 3 per 28 days PA | QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Cimzia
Tier 5 - Specialty 3 per 28 days PA | QL
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Cimzia
Tier 5 - Specialty 3 per 28 days PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 13 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Cimzia
Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026
via Cimzia
Not Covered None
NC State Health Plan - 80/20 Plus PPO 2026
via Cimzia
Not Covered None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 13 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via certolizumab pegol
Tier 3 - Non-Formulary PA | QL
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 13 hours, 22 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026
via Cimzia
Unknown PA | QL
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