Rhogam Ultra-Filtered Plu Sosy

1500UNIT

250UNIT

Also known as: RHOGAM ULTRA-FILTERED PLU SOSY 1500UNIT

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 15 hours, 1 minute ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Medical Benefit — — — None
NC State Health Plan - HDHP 2026 Medical Benefit — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Medical Benefit — — — None
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