Pertzye

Generic: lipase

4000UNIT — Capsule

Pancreatic Enzymes

Also known as: PERTZYE CAP 4000UNIT PERTZYE CAP 8000UNIT PERTZYE CAP 16000U PERTZYE CAP 24000U
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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: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 16 hours, 58 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via Viokace 		Tier 2 - Preferred Brand — — — None
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 Standard Option 2026 Tier 3 - Non-Preferred Brand — — — None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 16 hours, 58 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze CMS Standard
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Silver RD CMS Standard
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Silver CMS Standard
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Bronze 6500 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Silver 3000 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 5000 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Silver 4400 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Bronze 7000 HSA Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 3500 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 5000 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Silver 3500 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD 6000 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Bronze 5500 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Bronze
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Gold 1500 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Silver RD 2200 Indiv Med Deductible
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect myDiabetesCare Silver
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Gold CMS Standard
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Bronze RD CMS Standard
via Viokace 		Tier 4 - Non-Preferred — — — None
Connect Gold RD CMS Standard
via Viokace 		Tier 4 - Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 16 hours, 58 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred — — — None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 16 hours, 58 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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 - HDHP 2026
via Viokace 		Tier 2 - Non-Preferred Generic — — — None
NC State Health Plan - HDHP 2026 Tier 3 - Non-Preferred Brand — — — 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
Source: CMS QHP JSON  ·  Checked: 16 hours, 58 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Simple Diabetes | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Bronze Simple Chronic Care CKM | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Bronze Classic Standard
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Gold Classic Standard
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Classic Standard
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Gold Elite Saver Plus | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Simple PCP Saver | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Simple Diabetes | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Classic | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Bronze Elite + PCP Saver Plus | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Bronze Classic 4700 | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Secure | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Simple Diabetes
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Gold Elite Saver Plus
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Simple PCP Saver
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Bronze Classic 4700
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Secure
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Classic
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Bronze Elite + PCP Saver Plus
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Gold Classic Standard | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Classic Standard | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Bronze Classic Standard | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
AIAN Cost Share
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
AIAN Cost Share | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Simple Chronic Care CKM | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Viokace 		Tier 3 - Preferred Brand ✓ — — PA
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