octreotide acetate subcutaneous
Prefilled Syringe
Hormonal Agents, Suppressant (pituitary)
Also known as:
Octreotide Acetate Subcutaneous Solution Prefilled Syringe
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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.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via Octreotide Acetate |
Tier 2 - Preferred Brand | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Octreotide Acetate |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Octreotide Acetate |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Advantage 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 Care 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 |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Octreotide Acetate |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
NC Medicaid PDL
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - HDHP 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 - 80/20 Plus PPO 2026
via Octreotide Acetate |
Tier 4 - Specialty Generic | ✓ | — | ✓ | PA | QL |