mirikizumab-mrkz

Generic: Omvoh

100 mg/mL, 200 mg/2 mL, 200 mg/2 mL (100 mg/mL x 2), 300 mg/3 mL (100 mg/mL x 1 and 200 mg/2 mL x 1) — Prefilled Syringe

Also known as: OMVOH OMVOH PEN

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

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026 via Omvoh	Tier 5 - Non-Preferred Specialty	✓	—	—	PA
BCBS Federal Standard Option 2026 via Omvoh	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Local 2026 via Omvoh	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Care 2026 via Omvoh	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Advantage 2026 via Omvoh	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Value 2026 via Omvoh	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026 via Omvoh	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 27 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Omvoh	Non-Preferred	✓	✓	—	PA \| ST

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 22 hours, 27 minutes ago

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