Skytrofa

Generic: lonapegsomatropin-tcgd

13.3 MG — Cartridge

Also known as: lonapegsomatropin-tcgd

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: 19 hours, 3 minutes ago

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

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 19 hours, 3 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Preferred	✓	—	—	PA

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 19 hours, 3 minutes ago

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