concizumab-mtci

150 mg/1.5 mL (100 mg/mL), 300 mg/3 mL (100 mg/mL), 60 mg/1.5 mL (40 mg/mL) — Pen Injector

Also known as: ALHEMO PEN

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

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 19 hours, 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA