Siliq

Generic: brodalumab

210 MG — Prefilled Syringe

Also known as: brodalumab

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

3 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 7 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Troy Medicare (HMO)	Tier 5 - Specialty	✓	—	✓ 4.5 per 28 days	PA \| QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 4.5 per 28 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 4.5 per 28 days	PA \| QL

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 7 minutes ago

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