lonapegsomatropin-tcgd

Generic: Skytrofa

0.7 mg, 1.4 mg, 1.8 mg, 11 mg, 13.3 mg, 2.1 mg, 2.5 mg, 3 mg, 3.6 mg, 4.3 mg, 5.2 mg, 6.3 mg, 7.6 mg, 9.1 mg — Cartridge

Also known as: SKYTROFA

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

3 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 16 hours, 10 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Troy Medicare (HMO) via Skytrofa	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via Skytrofa	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas VIP Care (HMO D-SNP) via Skytrofa	Tier 5 - Specialty	✓	—	—	PA

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 16 hours, 10 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Skytrofa	Preferred	✓	—	—	PA

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 16 hours, 10 minutes ago

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