LUPRON DEPOT (4-MONTH)- leuprolide acetate (4 month) for
30 mg — Injection
Also known as:
LUPRON DEPOT (4-MONTH) KIT 30MG
LUPRON DEPOT (4-MONTH)- leuprolide acetate (4 month) for inj kit 30 mg
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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.
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 2 - Preferred Brand | ✓ | — | — | PA |
| BCBS Federal Standard Option 2026 | Tier 4 - Preferred Specialty | ✓ | — | — | PA |
| BCBS Federal Basic Option 2026 | Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Care 2026 | Tier 5 - Specialty | — | — | — | None |
| BCBSNC Blue Value 2026 | Tier 5 - Specialty | — | — | — | None |
| BCBSNC Blue Advantage 2026 | Tier 5 - Specialty | — | — | — | None |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 5 - Specialty | — | — | — | None |
| BCBSNC Blue Local 2026 | Tier 5 - Specialty | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 80/20 Plus PPO 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Not Covered | — | — | — | None |