Iqirvo

Generic: elafibranor

80 MG — Tablet

Also known as: elafibranor IQIRVO TABS 80MG

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

2 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 19 hours, 52 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

5 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 19 hours, 52 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Advantage 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
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

7 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 19 hours, 52 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
HealthSpring Preferred Savings (HMO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
HealthSpring Preferred Plus (HMO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
HealthSpring True Choice (PPO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
HealthSpring TotalCare Plus (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
HealthSpring TotalCare (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
HealthSpring Preferred (HMO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL
HealthSpring Preferred Select (HMO)	Tier 5 - Specialty	✓	—	✓ 30 per 30 days	PA \| QL

1 plan

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 19 hours, 52 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	✓	—	ST

3 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 19 hours, 52 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	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓	PA \| QL
NC State Health Plan - HDHP 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓	PA \| QL