Sivextro
Generic: tedizolid phosphate
200 MG — Tablet
Also known as:
Sivextro Oral
tedizolid phosphate
SIVEXTRO TABS 200MG
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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.
Blue Cross Blue Shield Federal
2 plansMedicare Part D
39 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature Giveback (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| HealthSpring True Choice (PPO) | Tier 5 - Specialty | — | — | ✓ 6 per 28 days | QL |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Experience Health Medicare Advantage (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| HealthSpring Preferred Plus (HMO) | Tier 5 - Specialty | — | — | ✓ 6 per 28 days | QL |
| HealthSpring Preferred Savings (HMO) | Tier 5 - Specialty | — | — | ✓ 6 per 28 days | QL |
| HealthSpring Preferred Select (HMO) | Tier 5 - Specialty | — | — | ✓ 6 per 28 days | QL |
| HealthSpring TotalCare (HMO D-SNP) | Tier 5 - Specialty | — | — | ✓ 6 per 28 days | QL |
| HealthSpring Preferred (HMO) | Tier 5 - Specialty | — | — | ✓ 6 per 28 days | QL |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 5 - Specialty | — | — | ✓ 6 per 28 days | QL |
| Aetna Medicare Signature (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Value Plus (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Prime (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature Care (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Enhanced (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 5 - Specialty | — | — | — | None |
| Blue Medicare PPO Enhanced (PPO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Essential Plus (HMO-POS) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Enhanced (HMO-POS) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Choice (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Blue Medicare Essential (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Platinum (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health smartHMO (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Platinum Select (HMO) | Tier 5 - Specialty | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 5 - Specialty | ✓ | — | — | PA |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature Extra (PPO) | Tier 5 - Specialty | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Bronze Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic | Tier 4 - Non-Preferred | — | — | — | None |
| Secure | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic 4700 | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple PCP Saver | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Elite Saver Plus | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Diabetes | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Secure | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Diabetes | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple PCP Saver | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Diabetes | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| AIAN Cost Share | Tier 4 - Non-Preferred | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
UnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| 54332NC0060009 | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| 54332NC0060010 | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Standard (No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| 54332NC0030042 | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| 54332NC0060008 | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Standard (No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Standard (No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 4 - Non-Preferred | ✓ | — | ✓ | PA | QL |