mitapivat sulfate

100 mg — Tablet

Also known as: AQVESME

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

5 plans

Source: PDF · Formulary date: Aug 1, 2026 · Checked: 8 hours, 59 minutes ago

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

3 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 8 hours, 59 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Aqvesme	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Aqvesme	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Aqvesme	Not Covered	—	—	—	None

1 plan

Source: Excel (XLSX) · Formulary date: Jul 31, 2026 · Checked: 8 hours, 59 minutes ago

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