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, Retacrit Injection Solution

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: 16 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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
Elite Bronze 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
Everyday Bronze with Atrium Health Tier 5 - Specialty PA
Complete Gold Tier 5 - Specialty PA
Elite Bronze + Vision + Adult Dental 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
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
Standard Gold Tier 5 - Specialty PA
Focused Silver with Atrium Health Tier 5 - Specialty PA
Standard Silver Tier 5 - Specialty PA
Standard Expanded Bronze Tier 5 - Specialty PA
Clear Silver with $0 Insulin Options Tier 5 - Specialty PA
Elite Bronze Tier 5 - Specialty PA
Everyday Bronze Tier 5 - Specialty PA
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 5 - Specialty PA
Source: CMS QHP JSON  ·  Checked: 16 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 3 - Preferred Brand PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 3 - Preferred Brand PA
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 3 - Preferred Brand PA
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 3 - Preferred Brand PA
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 3 - Preferred Brand PA
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 3 - Preferred Brand PA
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 3 - Preferred Brand PA
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 3 - Preferred Brand PA
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 3 - Preferred Brand PA
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 3 - Preferred Brand PA
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 16 hours, 56 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: Jul 1, 2026  ·  Checked: 16 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Care 2026 Tier 5 - Specialty PA
BCBSNC Blue Advantage 2026 Tier 5 - Specialty PA
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 5 - Specialty PA
BCBSNC Blue Value 2026 Tier 5 - Specialty PA
BCBSNC Blue Local 2026 Tier 5 - Specialty PA
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 16 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic PA
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic PA
Provider Partners North Carolina Advantage 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
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic PA
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
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 3 - Preferred Brand PA
Wellcare Simple (HMO-POS) 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
Liberty Medicare Advantage (HMO C-SNP) Tier 3 - Preferred Brand 12 per 28 days PA | QL
Wellcare Giveback Open (PPO) Tier 3 - Preferred Brand PA
Wellcare Dual Liberty Open (PPO D-SNP) Tier 3 - Preferred Brand PA
Wellcare Assist Open (PPO) Tier 3 - Preferred Brand PA
Wellcare Dual Access (HMO-POS D-SNP) Tier 3 - Preferred Brand PA
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 3 - Preferred Brand PA
Humana Dual Select H5525-072 (PPO D-SNP) Tier 4 - Non-Preferred 14 per 30 days PA | QL
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 Heart & Diabetes Care (HMO C-SNP) 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 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
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
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
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 16 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Preferred PA
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 16 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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
NC State Health Plan - HDHP 2026 Tier 4 - Specialty Generic PA
Source: CMS QHP JSON  ·  Checked: 16 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AIAN Cost Share | with Atrium Health Tier 5 - Specialty PA
Bronze Simple Diabetes | with Atrium Health Tier 5 - Specialty PA
Silver Simple Chronic Care CKM | with Atrium Health Tier 5 - Specialty PA
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 5 - Specialty PA
AIAN Cost Share Tier 5 - Specialty PA
Silver Simple PCP Saver Tier 5 - Specialty PA
Gold Elite Saver Plus Tier 5 - Specialty PA
Silver Simple Diabetes Tier 5 - Specialty PA
Secure | with Atrium Health Tier 5 - Specialty PA
Bronze Classic 4700 | with Atrium Health Tier 5 - Specialty PA
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 5 - Specialty PA
Silver Classic | with Atrium Health Tier 5 - Specialty PA
Silver Simple Diabetes | with Atrium Health Tier 5 - Specialty PA
Silver Simple PCP Saver | with Atrium Health Tier 5 - Specialty PA
Gold Elite Saver Plus | with Atrium Health Tier 5 - Specialty PA
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 5 - Specialty PA
Bronze Simple Chronic Care CKM | with Atrium Health Tier 5 - Specialty PA
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 5 - Specialty PA
Bronze Classic Standard Tier 5 - Specialty PA
Silver Classic Standard Tier 5 - Specialty PA
Gold Classic Standard Tier 5 - Specialty PA
Bronze Classic Standard | with Atrium Health Tier 5 - Specialty PA
Silver Classic Standard | with Atrium Health Tier 5 - Specialty PA
Gold Classic Standard | with Atrium Health Tier 5 - Specialty PA
Bronze Elite + PCP Saver Plus Tier 5 - Specialty PA
Silver Classic Tier 5 - Specialty PA
Secure Tier 5 - Specialty PA
Bronze Classic 4700 Tier 5 - Specialty PA
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 16 hours, 56 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 5 - Specialty QL
UHC Gold Standard (No Referrals) Tier 5 - Specialty QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 5 - Specialty QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 5 - Specialty QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 5 - Specialty QL
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 5 - Specialty QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 5 - Specialty QL
UHC Bronze Standard (No Referrals) Tier 5 - Specialty QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 5 - Specialty QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 5 - Specialty QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 5 - Specialty QL
UHC Silver Standard (No Referrals) Tier 5 - Specialty QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 5 - Specialty QL
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