Hyrimoz Soaj

40MG/0.4ML

Also known as: HYRIMOZ SOAJ 40MG/0.4ML; SOSY 20MG/0.2ML, 40MG/0.4ML HYRIMOZ SOAJ 40MG/0.4ML; SOSY

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

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 6 hours, 4 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓ Except NDCs	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓ Except NDCs	PA \| QL
NC State Health Plan - HDHP 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓ Except NDCs	PA \| QL