Orencia Sosy

50MG/0.4ML, 87.5MG/0.7ML, 125MG

Also known as: ORENCIA SOSY 50MG/0.4ML, 87.5MG/0.7ML, 125MG/ML ORENCIA SOSY 50MG/0.4ML, 87.5MG/0.7ML ORENCIA SOSY 125MG/ML

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

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 4 hours, 43 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓ Preferred for	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓ Preferred for	PA \| QL
NC State Health Plan - HDHP 2026	Tier 5 - Preferred Brand Specialty	✓	—	✓ Preferred for	PA \| QL