Doptelet

Generic: avatrombopag

20 MG — Tablet

HEMATOPOIETIC AGENTS

Also known as: avatrombopag DOPTELET TABS 20MG Doptelet Tablet / Sprinkle
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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: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 5 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
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 5 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026 Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
BCBSNC Blue Value 2026 Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
BCBSNC Blue Advantage 2026 Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
BCBSNC Blue Care 2026 Tier 5 - Specialty ✓ — ✓ Limited Distribution PA | QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 16 hours, 5 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic ✓ — ✓ 60 per 30 days PA | QL
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 60 per 30 days PA | QL
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 60 per 30 days PA | QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 60 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
Erickson Advantage Signature (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
Erickson Advantage Freedom (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
Erickson Advantage Liberty (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
Erickson Advantage Champion (HMO-POS C-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
HealthSpring True Choice (PPO) Tier 5 - Specialty ✓ — — PA
HealthSpring TotalCare (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
HealthSpring TotalCare Plus (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
HealthSpring Preferred (HMO) Tier 5 - Specialty ✓ — — PA
HealthSpring Preferred Select (HMO) Tier 5 - Specialty ✓ — — PA
HealthSpring Preferred Savings (HMO) Tier 5 - Specialty ✓ — — PA
HealthSpring Preferred Plus (HMO) Tier 5 - Specialty ✓ — — PA
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED CORE 001 NC (HMO) Tier 5 - Specialty ✓ — — PA
DEVOTED GIVEBACK 002 NC (HMO) Tier 5 - Specialty ✓ — — PA
DEVOTED GIVEBACK 012 NC (HMO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE 001 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE 003 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE 005 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE 008 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 5 - Specialty ✓ — — PA
Liberty Medicare Advantage (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
Wellcare Simple Open (PPO) Tier 5 - Specialty ✓ — — PA
Wellcare Simple (HMO-POS) Tier 5 - Specialty ✓ — — PA
Wellcare Giveback Open (PPO) Tier 5 - Specialty ✓ — — PA
HealthTeam Advantage Plan I (PPO) Tier 5 - Specialty ✓ — — PA
HealthTeam Advantage Plan II (PPO) Tier 5 - Specialty ✓ — — PA
HealthTeam Advantage Vitality Plan (PPO) Tier 5 - Specialty ✓ — — PA
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
Troy Medicare (HMO) Tier 5 - Specialty ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Liberty Open (PPO D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Assist Open (PPO) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Access (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Senior Care (HMO I-SNP) Tier 5 - Specialty ✓ — ✓ 60 per 30 days PA | QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 90 per 30 days PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 5 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 5 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 5 - Preferred Brand Specialty ✓ — ✓ PA | QL
NC State Health Plan - 70/30 Standard PPO 2026 Tier 5 - Preferred Brand Specialty ✓ — ✓ PA | QL
NC State Health Plan - 80/20 Plus PPO 2026 Tier 5 - Preferred Brand Specialty ✓ — ✓ PA | QL
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