Retacrit

Generic: epoetin alfa-epbx

2000UNIT — Injection

HEMATOPOIETIC AGENTS

Also known as: RETACRIT SOLN 2000UNIT/ML, 3000UNIT/ML, 4000UNIT/ML, 10000UNIT/ML, 20000UNIT/2ML, 20000UNIT/ML, 40000UNIT/ML epoetin alfa-epbx RETACRIT SOLN 4000UNIT/ML, 10000UNIT/ML, 20000UNIT/2ML, 20000UNIT/ML, 40000UNIT/ML RETACRIT SOLN 2000UNIT/ML,
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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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Everyday 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
Standard Expanded Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Standard Silver + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Complete Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Elite Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Everyday Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Complete Gold with Atrium Health Tier 5 - Specialty ✓ — — PA
Standard Expanded Bronze with Atrium Health Tier 5 - Specialty ✓ — — PA
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Standard Gold with Atrium Health Tier 5 - Specialty ✓ — — PA
Complete Gold Tier 5 - Specialty ✓ — — PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 5 - Specialty ✓ — — PA
Standard Silver with Atrium Health Tier 5 - Specialty ✓ — — PA
Everyday Bronze Tier 5 - Specialty ✓ — — PA
Elite Bronze 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
Standard Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Standard Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Standard Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — — PA
Focused Silver with Atrium Health Tier 5 - Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026 Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Basic Option 2026 Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Standard Option 2026 Tier 4 - Preferred Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026 Tier 5 - Specialty ✓ — — PA
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 5 - Specialty ✓ — — PA
BCBSNC Blue Local 2026 Tier 5 - Specialty ✓ — — PA
BCBSNC Blue Care 2026 Tier 5 - Specialty ✓ — — PA
BCBSNC Blue Value 2026 Tier 5 - Specialty ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 17 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 12 per 28 days PA | QL
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 12 per 28 days PA | QL
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 12 per 28 days PA | QL
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic ✓ — ✓ 12 per 28 days PA | QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — — PA
Wellcare Simple (HMO-POS) Tier 3 - Preferred Brand ✓ — — PA
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 3 - Preferred Brand ✓ — — PA
Liberty Medicare Advantage (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 12 per 28 days PA | QL
Wellcare Dual Access (HMO-POS D-SNP) Tier 3 - Preferred Brand ✓ — — PA
Wellcare Assist Open (PPO) Tier 3 - Preferred Brand ✓ — — PA
Wellcare Dual Liberty Open (PPO D-SNP) Tier 3 - Preferred Brand ✓ — — PA
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 3 - Preferred Brand ✓ — — PA
Senior Care (HMO I-SNP) Tier 3 - Preferred Brand ✓ — ✓ 12 per 28 days PA | QL
Wellcare Simple Open (PPO) Tier 3 - Preferred Brand ✓ — — PA
Wellcare Giveback Open (PPO) Tier 3 - Preferred Brand ✓ — — PA
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 4 - Non-Preferred ✓ — — PA
HealthSpring True Choice (PPO) Tier 4 - Non-Preferred ✓ — — PA
HealthSpring TotalCare (HMO D-SNP) Tier 4 - Non-Preferred ✓ — — PA
HealthSpring TotalCare Plus (HMO D-SNP) Tier 4 - Non-Preferred ✓ — — PA
HealthSpring Preferred (HMO) Tier 4 - Non-Preferred ✓ — — PA
HealthSpring Preferred Select (HMO) Tier 4 - Non-Preferred ✓ — — PA
HealthSpring Preferred Savings (HMO) Tier 4 - Non-Preferred ✓ — — PA
HealthSpring Preferred Plus (HMO) Tier 4 - Non-Preferred ✓ — — PA
Blue Medicare PPO Enhanced (PPO) Tier 4 - Non-Preferred ✓ — — PA
Blue Medicare Essential Plus (HMO-POS) Tier 4 - Non-Preferred ✓ — — PA
Blue Medicare Enhanced (HMO-POS) Tier 4 - Non-Preferred ✓ — — PA
Blue Medicare Choice (HMO) Tier 4 - Non-Preferred ✓ — — PA
Blue Medicare Essential (HMO) Tier 4 - Non-Preferred ✓ — — PA
Experience Health Medicare Advantage (HMO) Tier 4 - Non-Preferred ✓ — — PA
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 4 - Non-Preferred ✓ — — PA
Alignment Health Platinum (HMO) Tier 4 - Non-Preferred ✓ — — PA
Alignment Health NC Duals (HMO-POS D-SNP) Tier 4 - Non-Preferred ✓ — — PA
Alignment Health smartHMO (HMO) Tier 4 - Non-Preferred ✓ — — PA
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 4 - Non-Preferred ✓ — — PA
Alignment Health Platinum Select (HMO) Tier 4 - Non-Preferred ✓ — — PA
Alignment Health AVA (PPO) Tier 4 - Non-Preferred ✓ — — PA
HealthTeam Advantage Plan I (PPO) Tier 4 - Non-Preferred ✓ — — PA
HealthTeam Advantage Plan II (PPO) Tier 4 - Non-Preferred ✓ — — PA
HealthTeam Advantage Vitality Plan (PPO) Tier 4 - Non-Preferred ✓ — — PA
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 4 - Non-Preferred ✓ — — PA
Troy Medicare (HMO) Tier 4 - Non-Preferred ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 4 - Non-Preferred ✓ — — PA
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 4 - Non-Preferred ✓ — — PA
Humana Gold Plus H6622-057 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus H6622-060 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus H6622-061 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Choice H8145-004 (PFFS) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus H1036-137 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus H1036-233 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Dual Select H1036-307 (HMO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus H1036-335 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
HumanaChoice Giveback H5216-017 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
HumanaChoice H5216-211 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Full Access H5525-034 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
HumanaChoice Giveback H5525-035 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
HumanaChoice H5525-049 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
HumanaChoice H5525-050 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
HumanaChoice H5525-070 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Dual Select H5525-072 (PPO D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
HumanaChoice H5525-083 (PPO) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus H6622-025 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Gold Plus H6622-026 (HMO-POS) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 4 - Non-Preferred ✓ — ✓ 14 per 30 days PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026 Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 80/20 Plus PPO 2026 Tier 4 - Specialty Generic ✓ — — PA
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 32 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026 Unknown — — ✓ QL
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