Erzofri Intramuscular
351 MG/2.25ML — Prefilled Syringe
Also known as:
Erzofri Intramuscular Suspension Prefilled Syringe
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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.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
Medicare Part D
40 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Troy Medicare (HMO) | Tier 5 - Specialty | ✓ | — | ✓ 2.25 per 28 days | PA | QL |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 2.25 per 28 days | PA | QL |
| DEVOTED CORE 001 NC (HMO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Signature Extra (PPO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Signature Giveback (PPO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 2.25 per 28 days | PA | QL |
| Aetna Medicare Signature (HMO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED CHOICE 003 NC (PPO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED CHOICE 005 NC (PPO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED CHOICE 008 NC (PPO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| DEVOTED CHOICE 001 NC (PPO) | Tier 5 - Specialty | — | — | ✓ 4.5 per 365 days | QL |
| Aetna Medicare Dual (HMO D-SNP) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Signature (HMO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Value Plus (HMO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Prime (HMO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Signature Care (HMO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Enhanced (HMO) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 5 - Specialty | — | — | ✓ 4.50 per 365 days | QL |