Myleran

Generic: busulfan

2 MG — Tablet

ANTINEOPLASTICS

Also known as: MYLERAN TABS 2MG busulfan Myleran 2 Mg Tablet
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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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver + Vision + Adult Dental
via busulfan 		Tier 5 - Specialty ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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
BCBSNC Blue Care 2026 Tier 5 - Specialty — — — None
BCBSNC Blue Value 2026 Tier 5 - Specialty — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver 3000 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Bronze 6500 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Silver CMS Standard Tier 4 - Non-Preferred — — — None
Connect Silver RD CMS Standard Tier 4 - Non-Preferred — — — None
Connect Gold CMS Standard Tier 4 - Non-Preferred — — — None
Connect Bronze RD CMS Standard Tier 4 - Non-Preferred — — — None
Connect Gold RD CMS Standard Tier 4 - Non-Preferred — — — None
Connect Bronze CMS Standard Tier 4 - Non-Preferred — — — None
Connect Silver RD 2200 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Bronze RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Bronze 7000 HSA Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Silver 4400 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Silver RD 5000 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Bronze Tier 4 - Non-Preferred — — — None
Connect Gold 1500 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Silver Tier 4 - Non-Preferred — — — None
Connect Silver RD 3500 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Silver 3500 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Bronze RD 6000 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Connect Bronze 5500 Indiv Med Deductible Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via busulfan 		Tier 1 - Preferred Generic — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via busulfan 		Tier 1 - Preferred Generic — — — None
NC State Health Plan - HDHP 2026
via busulfan 		Tier 1 - Preferred Generic — — — None
NC State Health Plan - HDHP 2026 Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 3 - Non-Preferred Brand — — — None
Source: CMS QHP JSON  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Silver Classic | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Gold Elite Saver Plus | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
AIAN Cost Share
via busulfan 		Tier 2 - Generic — — — None
AIAN Cost Share | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Bronze Classic Standard
via busulfan 		Tier 2 - Generic — — — None
Silver Classic Standard
via busulfan 		Tier 2 - Generic — — — None
Gold Classic Standard
via busulfan 		Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus
via busulfan 		Tier 2 - Generic — — — None
Silver Classic
via busulfan 		Tier 2 - Generic — — — None
Secure
via busulfan 		Tier 2 - Generic — — — None
Bronze Classic 4700
via busulfan 		Tier 2 - Generic — — — None
Silver Simple PCP Saver
via busulfan 		Tier 2 - Generic — — — None
Gold Elite Saver Plus
via busulfan 		Tier 2 - Generic — — — None
Silver Simple Diabetes
via busulfan 		Tier 2 - Generic — — — None
Secure | with Atrium Health
via busulfan 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 17 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Gold Standard (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Standard (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 4 - Non-Preferred — — — None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — — None
UHC Bronze Standard (No Referrals) Tier 4 - Non-Preferred — — — None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 4 - Non-Preferred — — — None
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