remibrutinib

25 mg — Tablet

Also known as: RHAPSIDO

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

6 plans

Source: CMS QHP JSON · Formulary date: Aug 19, 2026 · Checked: 8 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
PruittHealth Premier (HMO I-SNP) via Rhapsido	Tier 1 - Preferred Generic	✓	—	✓ 60 per 30 days	PA \| QL
NHC Advantage (HMO I-SNP) via Rhapsido	Tier 1 - Preferred Generic	✓	—	✓ 60 per 30 days	PA \| QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) via Rhapsido	Tier 1 - Preferred Generic	✓	—	✓ 60 per 30 days	PA \| QL
Liberty Medicare Dual Plan (HMO D-SNP) via Rhapsido	Tier 1 - Preferred Generic	✓	—	✓ 60 per 30 days	PA \| QL
Liberty Medicare Advantage (HMO C-SNP) via Rhapsido	Tier 5 - Specialty	✓	—	✓ 60 per 30 days	PA \| QL
Senior Care (HMO I-SNP) via Rhapsido	Tier 5 - Specialty	✓	—	✓ 60 per 30 days	PA \| QL

1 plan

Source: Excel (XLSX) · Formulary date: Jul 31, 2026 · Checked: 8 hours, 39 minutes ago

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