Pertzye

Generic: lipase

4000UNIT — Capsule

Also known as: PERTZYE CAP 4000UNIT PERTZYE CAP 8000UNIT PERTZYE CAP 16000U PERTZYE CAP 24000U

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

4 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 1 hour, 17 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026 via Viokace	Tier 2 - Preferred Brand	—	—	—	None
BCBS Federal Basic Option 2026 via Viokace	Tier 2 - Preferred Brand	—	—	—	None
BCBS Federal Focus 2026 via Viokace	Tier 2 - Preferred Brand	—	—	—	None
BCBS Federal Standard Option 2026	Tier 3 - Non-Preferred Brand	—	—	—	None

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 1 hour, 17 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	—	—	None

6 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 1 hour, 17 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Viokace	Tier 2 - Non-Preferred Generic	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Viokace	Tier 2 - Non-Preferred Generic	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Viokace	Tier 2 - Non-Preferred Generic	—	—	—	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
NC State Health Plan - HDHP 2026	Tier 3 - Non-Preferred Brand	—	—	—	None