Keytruda Qlex
Generic: berahyaluronidase alfa-pmph
396 MG
Programmed Death Receptor-1 Blocking Antibody
Also known as:
berahyaluronidase alfa-pmph
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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.
Oscar Health
54 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Bronze Elite + PCP Saver Plus | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Classic 4700 | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Classic | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Secure | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Classic 4700 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple PCP Saver | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Diabetes | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Classic Standard | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Classic Standard | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Gold Classic Standard | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Classic Standard | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Classic Standard | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Gold Classic Standard | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Secure | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Classic | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Diabetes | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple PCP Saver | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Simple Diabetes | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010074 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010075 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010076 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010077 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010078 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010079 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010080 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010081 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010082 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010083 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010084 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010085 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Elite + PCP Saver Plus with Adult Dental & Vision | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Simple Diabetes | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Core Plan | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Core Plan | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Diabetes with Adult Dental & Vision | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010108 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010109 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010110 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010111 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010112 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010113 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010114 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010115 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010116 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| 69803NC0010117 | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
| Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health | Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |