plerixafor

24mg/1.2ml — Solution

Also known as: plerixafor soln 24mg/1.2ml

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: 14 hours, 23 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 4 - Specialty Generic	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026	Tier 4 - Specialty Generic	✓	—	—	PA
NC State Health Plan - HDHP 2026	Tier 4 - Specialty Generic	✓	—	—	PA

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 14 hours, 23 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026	Unknown	—	—	—	None