Hemlibra
Generic: emicizumab-kxwh
12MG/0.4ML, 30MG — Solution
Also known as:
HEMLIBRA SOLN 12MG/0.4ML, 30MG/ML, 60MG/0.4ML, 105MG/0.7ML, 150MG/ML, 300MG/2ML
HEMLIBRA SOLN 12MG/0.4ML, 30MG/ML,
emicizumab-kxwh
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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.
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 2 - Preferred Brand | — | — | — | None |
| BCBS Federal Basic Option 2026 | Tier 4 - Preferred Specialty | — | — | — | None |
| BCBS Federal Standard Option 2026 | Tier 4 - Preferred Specialty | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Advantage 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
| BCBSNC Blue Local 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
| BCBSNC Blue Care 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
| BCBSNC Blue Value 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 6 - Non-Preferred Brand Specialty | ✓ | — | — | PA |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 6 - Non-Preferred Brand Specialty | ✓ | — | — | PA |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 6 - Non-Preferred Brand Specialty | ✓ | — | — | PA |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Silver Simple PCP Saver | Tier 5 - Specialty | ✓ | — | — | PA |
| Gold Elite Saver Plus | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple Diabetes | Tier 5 - Specialty | ✓ | — | — | PA |
| Secure | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Classic 4700 | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Classic | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple Diabetes | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple PCP Saver | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Gold Elite Saver Plus | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Simple Diabetes | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| AIAN Cost Share | Tier 5 - Specialty | ✓ | — | — | PA |
| AIAN Cost Share | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Classic Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Classic Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Gold Classic Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Classic Standard | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Classic Standard | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Gold Classic Standard | with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Elite + PCP Saver Plus | Tier 5 - Specialty | ✓ | — | — | PA |
| Silver Classic | Tier 5 - Specialty | ✓ | — | — | PA |
| Secure | Tier 5 - Specialty | ✓ | — | — | PA |
| Bronze Classic 4700 | Tier 5 - Specialty | ✓ | — | — | PA |