Leukine
Generic: sargramostim
0.25 MG — Injection
Also known as:
sargramostim
Leukine 250 Mcg Vial
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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)
29 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Silver + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Gold + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Complete Gold | Tier 5 - Specialty | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 5 - Specialty | ✓ | — | — | PA |
| Everyday Bronze | Tier 5 - Specialty | ✓ | — | — | PA |
| Elite Bronze | Tier 5 - Specialty | ✓ | — | — | PA |
| Clear Silver with $0 Insulin Options | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Expanded Bronze | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Silver | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Gold | Tier 5 - Specialty | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Elite Bronze with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Focused Silver with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Complete Gold with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Expanded Bronze with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Silver with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Standard Gold with Atrium Health | Tier 5 - Specialty | ✓ | — | — | PA |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Complete Gold + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Everyday Bronze + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Elite Bronze + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Advantage 2026 | Tier 5 - Specialty | ✓ | — | — | PA |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 5 - Specialty | ✓ | — | — | PA |
| BCBSNC Blue Local 2026 | Tier 5 - Specialty | ✓ | — | — | PA |
| BCBSNC Blue Care 2026 | Tier 5 - Specialty | ✓ | — | — | PA |
| BCBSNC Blue Value 2026 | Tier 5 - Specialty | ✓ | — | — | PA |
Cigna
1 planMedicare Part D
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Troy Medicare (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |