peginterferon beta-1a
Generic: Plegridy
125 mcg/0.5 mL, 63 mcg/0.5 mL (1)-94 mcg/0.5 mL (1) — Prefilled Syringe
Also known as:
PLEGRIDY
PLEGRIDY PEN
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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.
Ambetter (Centene)
29 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via Plegridy |
Tier 2 - Preferred Brand | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Plegridy |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Plegridy |
Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Care 2026
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Value 2026
via Plegridy Starter Pack |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Care 2026
via Plegridy Starter Pack |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Local 2026
via Plegridy Starter Pack |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Plegridy Starter Pack |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Advantage 2026
via Plegridy Starter Pack |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Value 2026
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Advantage 2026
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
|
BCBSNC Blue Local 2026
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access; Limited Distribution | PA | QL |
Medicare Part D
14 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NHC Advantage (HMO I-SNP)
via Plegridy |
Tier 1 - Preferred Generic | — | — | ✓ 1 per 28 days | QL |
|
Longevity Health Plan (HMO I-SNP)
via Plegridy |
Tier 1 - Preferred Generic | ✓ | — | ✓ 1 per 28 days | PA | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Plegridy |
Tier 1 - Preferred Generic | — | — | ✓ 1 per 28 days | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Plegridy |
Tier 1 - Preferred Generic | — | — | ✓ 1 per 28 days | QL |
|
PruittHealth Premier (HMO I-SNP)
via Plegridy |
Tier 1 - Preferred Generic | — | — | ✓ 1 per 28 days | QL |
|
Blue Medicare Essential (HMO)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ 1 per 28 days | PA | QL |
|
Blue Medicare Choice (HMO)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ 1 per 28 days | PA | QL |
|
Blue Medicare Enhanced (HMO-POS)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ 1 per 28 days | PA | QL |
|
Blue Medicare Essential Plus (HMO-POS)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ 1 per 28 days | PA | QL |
|
Blue Medicare PPO Enhanced (PPO)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ 1 per 28 days | PA | QL |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ 1 per 28 days | PA | QL |
|
Experience Health Medicare Advantage (HMO)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ 1 per 28 days | PA | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via Plegridy |
Tier 5 - Specialty | — | — | ✓ 1 per 28 days | QL |
|
Senior Care (HMO I-SNP)
via Plegridy |
Tier 5 - Specialty | — | — | ✓ 1 per 28 days | QL |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via Plegridy |
Tier 6 - Non-Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Plegridy |
Tier 6 - Non-Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
|
NC State Health Plan - HDHP 2026
via Plegridy |
Tier 6 - Non-Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Bronze Classic 4700 | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Simple Diabetes | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Gold Elite Saver Plus | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple PCP Saver | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple Diabetes | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Classic | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple Chronic Care CKM | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Secure | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple Diabetes
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Gold Elite Saver Plus
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple PCP Saver
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Classic Standard
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Classic 4700
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Secure
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Classic
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Elite + PCP Saver Plus
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Gold Classic Standard | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Classic Standard | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Classic Standard | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Gold Classic Standard
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Classic Standard
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AIAN Cost Share | with Atrium Health
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
AIAN Cost Share
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
TRICARE
1 planUnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Bronze Standard (No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Standard (No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Standard (No Referrals)
via Plegridy |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |