eltrombopag olamine Suspension

Tablet

Also known as: Promacta

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 of NC

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 18 hours 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

Medicare Part D

25 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 18 hours 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

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 18 hours ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	—	—	None