Jatenzo

Generic: testosterone undecanoate

158MG, 198MG, 237MG — Capsule

Also known as: JATENZO CAPS 158MG, 198MG, 237MG

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

2 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 15 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Basic Option 2026	Tier 3 - Non-Preferred Brand	✓	—	—	PA

6 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 15 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Kyzatrex	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Tlando	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Tlando	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Tlando	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Kyzatrex	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Kyzatrex	Not Covered	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Jul 31, 2026 · Checked: 15 hours, 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via testosterone undecanoate	Tier 3 - Non-Formulary	✓	—	—	PA