Gattex

Generic: teduglutide

5 Mg — Vial

GASTROINTESTINAL AGENTS- MISC.

Also known as: teduglutide GATTEX KIT 5MG Gattex 5 Mg Vial Gattex 5 Mg 30-Vial Kit Gattex 5 Mg One-Vial Kit Gattex Subcutaneous Kit

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: Sep 22, 2026  ·  Checked: 10 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Signature + 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
AmeriHealth Caritas Next Silver Premier + 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 Gold Signature + 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 Gold Enhanced + 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 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 Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + 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
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 10 hours, 25 minutes ago
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
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 10 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Care 2026 Tier 5 - Specialty ✓ — — Limited Distribution PA
BCBSNC Blue Local 2026 Tier 5 - Specialty ✓ — — Limited Distribution PA
BCBSNC Blue Value 2026 Tier 5 - Specialty ✓ — — Limited Distribution PA
BCBSNC Blue Advantage 2026 Tier 5 - Specialty ✓ — — Limited Distribution PA
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 5 - Specialty ✓ — — Limited Distribution PA
Source: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 10 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver RD CMS Standard Tier 5 - Specialty ✓ — — PA
Connect Silver 3600 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Bronze CMS Standard Tier 5 - Specialty ✓ — — PA
Connect myDiabetesCare Bronze Tier 5 - Specialty ✓ — — PA
Connect Silver 5000 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Silver 3000 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Silver CMS Standard Tier 5 - Specialty ✓ — — PA
Connect Gold 1500 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Bronze RD 6000 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Bronze RD CMS Standard Tier 5 - Specialty ✓ — — PA
Connect Silver RD 3500 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Silver RD 5000 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Silver RD 2200 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Gold RD CMS Standard Tier 5 - Specialty ✓ — — PA
Connect Bronze 7000 HSA Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Bronze 5500 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Gold CMS Standard Tier 5 - Specialty ✓ — — PA
Connect myDiabetesCare Silver Tier 5 - Specialty ✓ — — PA
Connect Bronze RD 5000 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Connect Bronze 6500 Indiv Med Deductible Tier 5 - Specialty ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 10 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
DEVOTED CORE 001 NC (HMO) Tier 5 - Specialty ✓ — — PA
DEVOTED GIVEBACK 002 NC (HMO) Tier 5 - Specialty ✓ — — PA
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED GIVEBACK 012 NC (HMO) Tier 5 - Specialty ✓ — — PA
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Enhanced (PPO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Enhanced (PPO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Signature Extra (PPO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Signature Giveback (PPO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — — PA
Alignment Health AVA (PPO) Tier 5 - Specialty ✓ — — PA
HealthSpring True Choice (PPO) Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE 001 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE 003 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE 005 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE 008 NC (PPO) Tier 5 - Specialty ✓ — — PA
Alignment Health Platinum (HMO) Tier 5 - Specialty ✓ — — PA
Alignment Health Platinum Select (HMO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Signature (HMO) Tier 5 - Specialty ✓ — — PA
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 5 - Specialty ✓ — — PA
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Dual (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
HealthSpring Preferred (HMO) Tier 5 - Specialty ✓ — — PA
HealthSpring TotalCare Plus (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
HealthSpring Preferred Select (HMO) Tier 5 - Specialty ✓ — — PA
HealthSpring Preferred Savings (HMO) Tier 5 - Specialty ✓ — — PA
HealthSpring Preferred Plus (HMO) Tier 5 - Specialty ✓ — — PA
HealthSpring TotalCare (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
Alignment Health smartHMO (HMO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Signature (HMO) Tier 5 - Specialty ✓ — — PA
Alignment Health NC Duals (HMO-POS D-SNP) Tier 5 - Specialty ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
Troy Medicare (HMO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Enhanced (HMO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Chronic Care (HMO C-SNP) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Signature Care (HMO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Prime (HMO) Tier 5 - Specialty ✓ — — PA
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 5 - Specialty ✓ — — PA
Aetna Medicare Value Plus (HMO) Tier 5 - Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 10 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 6 - Non-Preferred Brand Specialty ✓ — ✓ PA | QL
NC State Health Plan - HDHP 2026 Tier 6 - Non-Preferred Brand Specialty ✓ — ✓ PA | QL
NC State Health Plan - 70/30 Standard PPO 2026 Tier 6 - Non-Preferred Brand Specialty ✓ — ✓ PA | QL
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