LUPRON DEPOT (6-MONTH)- leuprolide acetate (6 month) for

45 mg — Injection

ANTINEOPLASTICS

Also known as: LUPRON DEPOT (6-MONTH) KIT 45MG LUPRON DEPOT (6-MONTH)- leuprolide acetate (6 month) for inj kit 45 mg

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 3 hours, 36 minutes ago
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
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 3 hours, 36 minutes ago
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
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 3 hours, 36 minutes ago
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
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