tirbanibulin

Generic: Klisyri

1 % — Ointment

Also known as: KLISYRI

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

7 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 12 hours, 34 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
HealthSpring Preferred Plus (HMO) via Klisyri	Tier 4 - Non-Preferred	—	✓	✓ 5 per 30 days	ST \| QL
HealthSpring True Choice (PPO) via Klisyri	Tier 4 - Non-Preferred	—	✓	✓ 5 per 30 days	ST \| QL
HealthSpring TotalCare (HMO D-SNP) via Klisyri	Tier 4 - Non-Preferred	—	✓	✓ 5 per 30 days	ST \| QL
HealthSpring TotalCare Plus (HMO D-SNP) via Klisyri	Tier 4 - Non-Preferred	—	✓	✓ 5 per 30 days	ST \| QL
HealthSpring Preferred (HMO) via Klisyri	Tier 4 - Non-Preferred	—	✓	✓ 5 per 30 days	ST \| QL
HealthSpring Preferred Select (HMO) via Klisyri	Tier 4 - Non-Preferred	—	✓	✓ 5 per 30 days	ST \| QL
HealthSpring Preferred Savings (HMO) via Klisyri	Tier 4 - Non-Preferred	—	✓	✓ 5 per 30 days	ST \| QL

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 12 hours, 34 minutes ago

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