Proleukin

Generic: aldesleukin

Lymphocyte Growth Factor

Also known as: aldesleukin

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: 20 hours, 28 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold Tier 5 - Specialty PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 5 - Specialty PA
Everyday Bronze Tier 5 - Specialty PA
Elite Bronze Tier 5 - Specialty PA
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty PA
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty PA
Focused Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty PA
Complete Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty PA
Clear Silver with $0 Insulin Options Tier 5 - Specialty PA
Standard Expanded Bronze Tier 5 - Specialty PA
Standard Silver Tier 5 - Specialty PA
Standard Gold Tier 5 - Specialty PA
Everyday Bronze with Atrium Health Tier 5 - Specialty PA
Elite Bronze with Atrium Health Tier 5 - Specialty PA
Focused Silver with Atrium Health Tier 5 - Specialty PA
Complete Gold with Atrium Health Tier 5 - Specialty PA
Standard Expanded Bronze with Atrium Health Tier 5 - Specialty PA
Standard Silver with Atrium Health Tier 5 - Specialty PA
Standard Gold with Atrium Health Tier 5 - Specialty PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 5 - Specialty PA
Complete Gold + Vision + Adult Dental Tier 5 - Specialty PA
Everyday Bronze + Vision + Adult Dental Tier 5 - Specialty PA
Elite Bronze + Vision + Adult Dental Tier 5 - Specialty PA
Standard Expanded Bronze + Vision + Adult Dental Tier 5 - Specialty PA
Standard Silver + Vision + Adult Dental Tier 5 - Specialty PA
Standard Gold + Vision + Adult Dental Tier 5 - Specialty PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty PA
Standard Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty PA
Standard Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty PA
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