Mycapssa

Generic: octreotide acetate

OXYTOCICS

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: 18 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via Octreotide Acetate
Tier 2 - Preferred Brand PA
BCBS Federal Standard Option 2026
via Octreotide Acetate
Tier 4 - Preferred Specialty PA
BCBS Federal Basic Option 2026
via Octreotide Acetate
Tier 4 - Preferred Specialty PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 18 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026
via 1 Mg/Ml
Tier 2 - Medium Cost Generic/Brand PA | QL
BCBSNC Blue Local 2026
via 1 Mg/Ml
Tier 2 - Medium Cost Generic/Brand PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026
via 1 Mg/Ml
Tier 2 - Medium Cost Generic/Brand PA | QL
BCBSNC Blue Advantage 2026
via 1 Mg/Ml
Tier 2 - Medium Cost Generic/Brand PA | QL
BCBSNC Blue Care 2026
via 1 Mg/Ml
Tier 2 - Medium Cost Generic/Brand PA | QL
BCBSNC Blue Care 2026
via Octreotide Acetate
Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Value 2026
via Octreotide Acetate
Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026
via Octreotide Acetate
Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Advantage 2026 Tier 5 - Specialty Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 5 - Specialty Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Local 2026 Tier 5 - Specialty Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Care 2026 Tier 5 - Specialty Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Value 2026 Tier 5 - Specialty Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Advantage 2026
via Octreotide Acetate
Tier 5 - Specialty Restricted Access PA | QL
BCBSNC Blue Local 2026
via Octreotide Acetate
Tier 5 - Specialty Restricted Access PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 18 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Octreotide Acetate
Tier 4 - Specialty Generic PA | QL
NC State Health Plan - 70/30 Standard PPO 2026
via Octreotide Acetate
Tier 4 - Specialty Generic PA | QL
NC State Health Plan - HDHP 2026
via Octreotide Acetate
Tier 4 - Specialty Generic PA | QL
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 18 hours, 55 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via Octreotide Acetate
Tier 3 - Non-Formulary PA
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