Pyzchiva

Generic: ustekinumab-ttwe

45 MG, 90 MG, 130 MG — Prefilled Syringe

Also known as: PYZCHIVA SOLN 45MG/0.5ML; SOSY 45MG/0.5ML, 90MG/ML PYZCHIVA SOLN 130MG/26ML ustekinumab-ttwe PYZCHIVA SOAJ 45MG/0.5ML, 90MG/ML; SOLN 45MG/0.5ML; SOSY 45MG/0.5ML, 90MG/ML PYZCHIVA SOLN 45MG/0.5ML; SOSY

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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

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Elite Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health	Tier 5 - Specialty	✓	—	✓	PA \| QL

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026	Tier 2 - Preferred Brand	✓	—	—	PA
BCBS Federal Standard Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA

Cigna

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026 via Ustekinumab-Ttwe	Tier 4 - Specialty	✓	—	✓ Specialty Pharmacy Required	PA \| QL

Medicare Part D

60 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Longevity Health Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Dual Reserve (HMO-POS D-SNP) via Ustekinumab-Ttwe	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (HMO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Dual (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (HMO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Value Plus (HMO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Prime (HMO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature Care (HMO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Full Dual Care (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Enhanced (HMO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Enhanced (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Enhanced (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature Extra (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature Giveback (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Chronic Care (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Chronic Care Value (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED DUAL 009 NC (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CORE 001 NC (HMO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED GIVEBACK 002 NC (HMO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED GIVEBACK 012 NC (HMO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health Platinum Select (HMO)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health AVA (PPO)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Wellcare Dual Liberty Open (PPO D-SNP) via Ustekinumab-Ttwe	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Assist Open (PPO) via Ustekinumab-Ttwe	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Dual Access (HMO-POS D-SNP) via Ustekinumab-Ttwe	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Dual Liberty (HMO-POS D-SNP) via Ustekinumab-Ttwe	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE 001 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE 003 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE 005 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE 008 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO)	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Simple Open (PPO) via Ustekinumab-Ttwe	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Simple (HMO-POS) via Ustekinumab-Ttwe	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Giveback Open (PPO) via Ustekinumab-Ttwe	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Blue Medicare PPO Enhanced (PPO)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Blue Medicare Essential Plus (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Blue Medicare Enhanced (HMO-POS)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Blue Medicare Choice (HMO)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Blue Medicare Essential (HMO)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Experience Health Medicare Advantage (HMO)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Healthy Blue + Medicare (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health Platinum (HMO)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health NC Duals (HMO-POS D-SNP)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health smartHMO (HMO)	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Pyzchiva Syringe	Preferred	✓	✓	—	PA \| ST

NC State Health Plan

6 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 70/30 Standard PPO 2026 via Ustekinumab-Ttwe	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Ustekinumab-Ttwe	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Ustekinumab-Ttwe	Not Covered	—	—	—	None

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 20 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via Ustekinumab-Ttwe	Tier 3 - Non-Formulary	✓	—	—	PA