Ravicti
Generic: glycerol phenylbutyrate
1100 MG — Solution
Also known as:
glycerol phenylbutyrate
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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.
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Advantage 2026 | Tier 5 - Specialty | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 5 - Specialty | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Local 2026 | Tier 5 - Specialty | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Care 2026 | Tier 5 - Specialty | ✓ | — | — Restricted Access | PA |
| BCBSNC Blue Value 2026 | Tier 5 - Specialty | ✓ | — | — Restricted Access | PA |
Medicare Part D
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Troy Medicare (HMO)
via glycerol phenylbutyrate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via glycerol phenylbutyrate |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via glycerol phenylbutyrate |
Tier 5 - Specialty | ✓ | — | — | PA |