palonosetron

0.075 MG, 0.25 MG, 235 MG — Injection

Antiemetic-Antivertigo Agents

Also known as: Aloxi
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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: 14 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Focused Silver with Atrium Health Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options Tier 2 - Generic — — — None
Everyday Bronze Tier 2 - Generic — — — None
Elite Bronze Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options Tier 2 - Generic — — — None
Signature Expanded Bronze Tier 2 - Generic — — — None
Signature Silver Tier 2 - Generic — — — None
Signature Gold Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health Tier 2 - Generic — — — None
Elite Bronze with Atrium Health Tier 2 - Generic — — — None
Complete Gold Tier 2 - Generic — — — None
Complete Gold with Atrium Health Tier 2 - Generic — — — None
Signature Expanded Bronze with Atrium Health Tier 2 - Generic — — — None
Signature Silver with Atrium Health Tier 2 - Generic — — — None
Signature Gold with Atrium Health Tier 2 - Generic — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental Tier 2 - Generic — — — None
Complete Gold + Vision + Adult Dental Tier 2 - Generic — — — None
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic — — — None
Elite Bronze + Vision + Adult Dental Tier 2 - Generic — — — None
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Signature Expanded Bronze + Vision + Adult Dental Tier 2 - Generic — — — None
Signature Silver + Vision + Adult Dental Tier 2 - Generic — — — None
Signature Gold + Vision + Adult Dental Tier 2 - Generic — — — None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Signature Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Signature Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic — — — None
Enhanced CHF Heart Care Silver $0 Rx Options Tier 2 - Generic — — — None
Streamlined Silver with Atrium Health Tier 2 - Generic — — — None
Streamlined Silver Tier 2 - Generic — — — None
Clear Silver with $0 Insulin Options + Vision + Adult Dental Tier 2 - Generic — — — None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 14 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via Posfrea Ψ 		Tier 3 - Non-Preferred Brand ✓ — — PA
BCBS Federal Basic Option 2026
via Posfrea Ψ 		Tier 3 - Non-Preferred Brand ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 14 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Posfrea Ψ 		Non-Preferred — — — None
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 14 hours, 12 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Posfrea Ψ 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Posfrea Ψ 		Tier 3 - Non-Preferred Brand — — — None
NC State Health Plan - HDHP 2026
via Posfrea Ψ 		Tier 3 - Non-Preferred Brand — — — None
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