eltrombopag olamine Suspension

Tablet

Thrombopoiesis Stimulating Agents

Also known as: Promacta
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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: 14 hours, 30 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via Promacta 		Tier 5 - Specialty ✓ — ✓ Restricted Access PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026
via Promacta 		Tier 5 - Specialty ✓ — ✓ Restricted Access PA | QL
BCBSNC Blue Local 2026
via Promacta 		Tier 5 - Specialty ✓ — ✓ Restricted Access PA | QL
BCBSNC Blue Care 2026
via Promacta 		Tier 5 - Specialty ✓ — ✓ Restricted Access PA | QL
BCBSNC Blue Value 2026
via Promacta 		Tier 5 - Specialty ✓ — ✓ Restricted Access PA | QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 14 hours, 30 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
HumanaChoice H5216-211 (PPO)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Full Access H5525-034 (PPO)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
HumanaChoice Giveback H5525-035 (PPO)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
HumanaChoice H5525-049 (PPO)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
HumanaChoice H5525-050 (PPO)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
HumanaChoice H5525-070 (PPO)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Dual Select H5525-072 (PPO D-SNP)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
HumanaChoice H5525-083 (PPO)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus H6622-025 (HMO-POS)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus H6622-026 (HMO-POS)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus H6622-057 (HMO-POS)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus H6622-060 (HMO-POS)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus H6622-061 (HMO-POS)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Choice H8145-004 (PFFS)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus H1036-137 (HMO-POS)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus H1036-233 (HMO-POS)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Dual Select H1036-307 (HMO D-SNP)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Humana Gold Plus H1036-335 (HMO-POS)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
HumanaChoice Giveback H5216-017 (PPO)
via Promacta 		Tier 5 - Specialty ✓ — ✓ 360 per 30 days PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 14 hours, 30 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
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