fulvestrant sosy

Generic: fulvestrant

250mg/5ml

Estrogen Receptor Antagonist

Also known as: fulvestrant sosy 250mg/5ml
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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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 20 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental
via fulvestrant 		Tier 5 - Specialty ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 20 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026 Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - HDHP 2026 Tier 4 - Specialty Generic ✓ — — PA
Source: CMS QHP JSON  ·  Checked: 20 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Classic Standard
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Classic Standard
via fulvestrant 		Tier 5 - Specialty — — — None
Gold Classic Standard
via fulvestrant 		Tier 5 - Specialty — — — None
Bronze Classic Standard | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Classic Standard | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Gold Classic Standard | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Bronze Elite + PCP Saver Plus
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Classic
via fulvestrant 		Tier 5 - Specialty — — — None
Secure
via fulvestrant 		Tier 5 - Specialty — — — None
Bronze Classic 4700
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Simple PCP Saver
via fulvestrant 		Tier 5 - Specialty — — — None
Gold Elite Saver Plus
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Simple Diabetes
via fulvestrant 		Tier 5 - Specialty — — — None
Secure | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Bronze Classic 4700 | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Classic | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Simple Diabetes | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Simple PCP Saver | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Gold Elite Saver Plus | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Bronze Simple Diabetes | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
AIAN Cost Share
via fulvestrant 		Tier 5 - Specialty — — — None
AIAN Cost Share | with Atrium Health
via fulvestrant 		Tier 5 - Specialty — — — None
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