Fulphila
Generic: pegfilgrastim-jmdb
6MG/0.6ML — Prefilled Syringe
Also known as:
pegfilgrastim-jmdb
FULPHILA SOSY 6MG/0.6ML
Fulphila 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.
Ambetter (Centene)
34 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Signature Expanded Bronze + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Silver + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Gold + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Silver with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Gold with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Clear Silver with $0 Insulin Options | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Expanded Bronze | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Silver | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Gold | Tier 5 - Specialty | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Elite Bronze with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Focused Silver with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Complete Gold with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Expanded Bronze with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Silver with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Signature Gold with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Complete Gold + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Everyday Bronze + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Elite Bronze + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Complete Gold | Tier 5 - Specialty | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver $0 Rx Options | Tier 5 - Specialty | ✓ | — | — | PA |
| Everyday Bronze | Tier 5 - Specialty | ✓ | — | — | PA |
| Clear Silver with $0 Insulin Options + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Elite Bronze | Tier 5 - Specialty | ✓ | — | — | PA |
| Streamlined Silver | Tier 5 - Specialty | ✓ | — | — | PA |
| Streamlined Silver with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Enhanced CHF Heart Care Silver $0 Rx Options | Tier 5 - Specialty | ✓ | — | — | PA |
AmeriHealth Caritas NC
11 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 2 - Preferred Brand | ✓ | — | — | PA |
| BCBS Federal Basic Option 2026 | Tier 4 - Preferred Specialty | ✓ | — | — | PA |
| BCBS Federal Standard Option 2026 | Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Value 2026 | Tier 5 - Specialty | — | — | — | None |
| BCBSNC Blue Care 2026 | Tier 5 - Specialty | — | — | — | None |
| BCBSNC Blue Local 2026 | Tier 5 - Specialty | — | — | — | None |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 5 - Specialty | — | — | — | None |
| BCBSNC Blue Advantage 2026 | Tier 5 - Specialty | — | — | — | None |
Medicare Part D
51 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 5 - Specialty | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CHOICE 001 NC (PPO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED CHOICE 003 NC (PPO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED CHOICE 005 NC (PPO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED CHOICE 008 NC (PPO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| Alignment Health Platinum (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| Wellcare Simple Open (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Senior Care (HMO I-SNP) | Tier 5 - Specialty | — | — | — | None |
| Troy Medicare (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health smartHMO (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Platinum Select (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| DEVOTED CORE 001 NC (HMO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 5 - Specialty | ✓ | — | ✓ 1.2 per 28 days | PA | QL |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Experience Health Medicare Advantage (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Wellcare Assist Open (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Wellcare Giveback Open (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare PPO Enhanced (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Essential Plus (HMO-POS) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Enhanced (HMO-POS) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Choice (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Essential (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Wellcare Simple (HMO-POS) | Tier 5 - Specialty | ✓ | — | — | PA |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |