glycopyrrolate/formoterol fum

9-4.8 MCG — Inhaler

Also known as: BEVESPI AEROSPHERE

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

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 5 hours, 34 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Bevespi Aerosphere	Non-Preferred	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Oct 29, 2026 · Checked: 5 hours, 34 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via Bevespi Aerosphere	Tier 3 - Non-Formulary	—	—	✓ BEVESPI AEROSPHERE TO BE DISP AT MAX QTY OF 11GM (1 INH) PER DISP AT RTL OR 33GM (3 INH) AT MAIL	QL Quantity limit