Fragmin Subcutaneous
12500 UNIT/0.5ML — Prefilled Syringe
Also known as:
Fragmin Subcutaneous Solution 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 + No Referrals | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 4 - Non-Preferred | — | — | ✓ | QL |
Medicare Part D
25 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature Giveback (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 5 - Specialty | — | — | — | None |
| HealthTeam Advantage Plan I (PPO) | Tier 5 - Specialty | — | — | — | None |
| HealthTeam Advantage Plan II (PPO) | Tier 5 - Specialty | — | — | — | None |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 5 - Specialty | — | — | — | None |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Value Plus (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Prime (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature Care (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Enhanced (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature Extra (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |