Rotarix

Generic: rotavirus vaccine, live

Suspension

VACCINES

Also known as: ROTARIX SUS

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: Jul 1, 2026  ·  Checked: 19 hours, 53 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026 Tier A - ACA $0 Copay None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier A - ACA $0 Copay None
BCBSNC Blue Local 2026 Tier A - ACA $0 Copay None
BCBSNC Blue Care 2026 Tier A - ACA $0 Copay None
BCBSNC Blue Value 2026 Tier A - ACA $0 Copay None
BCBSNC Blue Advantage 2026
via Rotateq
Tier A - ACA $0 Copay None
BCBSNC Blue Home with UNC Health Alliance 2026
via Rotateq
Tier A - ACA $0 Copay None
BCBSNC Blue Local 2026
via Rotateq
Tier A - ACA $0 Copay None
BCBSNC Blue Care 2026
via Rotateq
Tier A - ACA $0 Copay None
BCBSNC Blue Value 2026
via Rotateq
Tier A - ACA $0 Copay None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 19 hours, 53 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 0 - $0 Copay (ACA Preventive) None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 0 - $0 Copay (ACA Preventive) None
NC State Health Plan - HDHP 2026 Tier 0 - $0 Copay (ACA Preventive) None
NC State Health Plan - 80/20 Plus PPO 2026
via Rotateq
Tier 0 - $0 Copay (ACA Preventive) None
NC State Health Plan - 70/30 Standard PPO 2026
via Rotateq
Tier 0 - $0 Copay (ACA Preventive) None
NC State Health Plan - HDHP 2026
via Rotateq
Tier 0 - $0 Copay (ACA Preventive) None
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