Forzinity

Generic: elamipretide HCl

280MG/3.5ML — Solution

Also known as: FORZINITY SOLN 280MG/3.5ML

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

2 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 13 hours, 45 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

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 13 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026	Not Covered	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Jul 31, 2026 · Checked: 13 hours, 44 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via elamipretide HCl	Tier 3 - Non-Formulary	✓	—	—	PA