elamipretide HCl
280 mg/3.5 mL (80 mg/mL) — Vial
IMMUNOLOGICAL AGENTS MISCELLANEOUS
Also known as:
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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.
Blue Cross Blue Shield Federal
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Standard Option 2026
via Forzinity |
Tier 5 - Non-Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Forzinity |
Tier 5 - Non-Preferred Specialty | ✓ | — | — | PA |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via Forzinity |
Not Covered | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Forzinity |
Not Covered | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Forzinity |
Not Covered | — | — | — | None |