Hyqvia 30 G / 300 ML Kit

Generic: hyaluronidase, human recombinant

100 MG

Coverage by Insurer

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

Ambetter (Centene)

116 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Focused Silver with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Complete Gold + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Silver + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Gold + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Clear Silver with $0 Insulin Options via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze	Tier 5 - Specialty	✓	—	—	PA
Clear Silver with $0 Insulin Options	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze	Tier 5 - Specialty	✓	—	—	PA
Standard Silver	Tier 5 - Specialty	✓	—	—	PA
Standard Gold	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	—	PA
Complete Gold via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Clear Silver with $0 Insulin Options via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health + Vision + Adult Dental via Hyqvia 20 G / 200 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health + Vision + Adult Dental via Hyqvia 2.5 G / 25 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Clear Silver with $0 Insulin Options via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Expanded Bronze with Atrium Health via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Silver with Atrium Health via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Standard Gold with Atrium Health via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Everyday Bronze with Atrium Health + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Elite Bronze with Atrium Health + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Focused Silver with Atrium Health + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA
Complete Gold with Atrium Health + Vision + Adult Dental via Hyqvia 5 G / 50 ML Kit	Tier 5 - Specialty	✓	—	—	PA