Hyrimoz
Generic: adalimumab-adaz
10 MG, 20 MG, 40 MG, 80 MG — Auto-Injector
ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES
Also known as:
HYRIMOZ SOAJ 40MG/0.4ML; SOSY 10MG/0.1ML, 20MG/0.2ML, 40MG/0.4ML
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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.
Ambetter (Centene)
34 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Complete Gold with Atrium Health
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver with Atrium Health
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold with Atrium Health
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze with Atrium Health
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Streamlined Silver
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Streamlined Silver with Atrium Health
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
Blue Cross Blue Shield Federal
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via adalimumab-adaz |
Tier 2 - Preferred Brand | ✓ | — | — | PA |
| 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 |
|
BCBS Federal Standard Option 2026
via adalimumab-adaz |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via adalimumab-adaz |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Home with UNC Health Alliance 2026
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Local 2026
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Care 2026
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Value 2026
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Advantage 2026
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
Medicare Part D
25 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Humana Gold Plus H6622-057 (HMO-POS)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus H1036-233 (HMO-POS)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
HumanaChoice Giveback H5216-017 (PPO)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
HumanaChoice H5216-211 (PPO)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Full Access H5525-034 (PPO)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
HumanaChoice Giveback H5525-035 (PPO)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
HumanaChoice H5525-049 (PPO)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
HumanaChoice H5525-050 (PPO)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
HumanaChoice H5525-070 (PPO)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
HumanaChoice H5525-083 (PPO)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus H6622-025 (HMO-POS)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus H6622-026 (HMO-POS)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus H6622-060 (HMO-POS)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
|
Humana Gold Choice H8145-004 (PFFS)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ 0.2 per 28 days | PA | QL |
TRICARE
1 planUnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via adalimumab-adaz |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |