Daybue

Generic: trofinetide

200MG — Solution

Also known as: DAYBUE SOLN 200MG/ML trofinetide

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

2 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 19 hours, 50 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

3 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 19 hours, 50 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL
NC State Health Plan - HDHP 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	✓	PA \| QL

13 plans

Source: PDF · Formulary date: Jun 23, 2026 · Checked: 19 hours, 50 minutes ago

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