Empaveli

Generic: pegcetacoplan

1080MG/20ML — Solution

Also known as: pegcetacoplan EMPAVELI SOLN 1080MG/20ML

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

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 10 hours, 59 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

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 10 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Local 2026	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Advantage 2026	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Value 2026	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Care 2026	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 5 - Specialty	✓	—	✓ Limited Distribution	PA \| QL

7 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 10 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Provider Partners North Carolina Essential Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	—	PA
Provider Partners North Carolina Advantage Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	—	PA
Provider Partners North Carolina Community Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	—	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

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 10 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 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 - HDHP 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓	PA \| QL