Hizentra

Generic: immunoglobulin G

1G — Solution

Also known as: HIZENTRA SOLN 1GM/5ML, 2GM/10ML, 4GM/20ML, 10GM/50ML; SOSY 10GM/50ML HIZENTRA SOLN 1GM/5ML, 2GM/10ML, 4GM/20ML, 10GM/50ML; SOSY 1GM/5ML, 2GM/10ML, 4GM/20ML, 10GM/50ML HIZENTRA SOLN 1GM/5ML, 2GM/10ML,

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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

10 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 1 hour, 17 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026 via Cuvitru	Tier 2 - Preferred Brand	✓	—	—	PA
BCBS Federal Focus 2026	Tier 2 - Preferred Brand	✓	—	—	PA
BCBS Federal Standard Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026 via Alyglo	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026 via Cuvitru	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026 via Cutaquig	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026 via Cutaquig	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026 via Cuvitru	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026 via Alyglo	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

NC State Health Plan

12 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 1 hour, 17 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026 via Cutaquig	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026 via Cutaquig	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - HDHP 2026 via Cutaquig	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 80/20 Plus PPO 2026 via Cuvitru	Medical Benefit	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Alyglo	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Alyglo	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Cuvitru	Medical Benefit	—	—	—	None
NC State Health Plan - HDHP 2026 via Cuvitru	Medical Benefit	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Alyglo	Not Covered	—	—	—	None