Trelstar Mixject Intramuscular
11.25 MG — Suspension
Gonadotropin Releasing Hormone Receptor Agonist
Also known as:
Trelstar Mixject Intramuscular Suspension Reconstituted
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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.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
Medicare Part D
56 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | ✓ | — | — | PA |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 1 per 28 days | QL |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 1 per 28 days | QL |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 1 per 28 days | QL |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | ✓ 1 per 28 days | QL |
| Blue Medicare Enhanced (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Blue Medicare Choice (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Blue Medicare Essential (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Experience Health Medicare Advantage (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health Platinum (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health smartHMO (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health Platinum Select (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Alignment Health AVA (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Troy Medicare (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus H1036-137 (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HumanaChoice H5216-211 (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Full Access H5525-034 (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HumanaChoice H5525-049 (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HumanaChoice H5525-050 (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HumanaChoice H5525-070 (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HumanaChoice H5525-083 (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Choice H8145-004 (PFFS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Senior Care (HMO I-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 28 days | QL |
| Blue Medicare Essential Plus (HMO-POS) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Blue Medicare PPO Enhanced (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 1 per 28 days | QL |
| HealthSpring Preferred Plus (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HealthSpring Preferred Savings (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HealthSpring Preferred Select (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HealthSpring Preferred (HMO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HealthSpring TotalCare (HMO D-SNP) | Tier 4 - Non-Preferred | ✓ | — | — | PA |
| HealthSpring True Choice (PPO) | Tier 4 - Non-Preferred | ✓ | — | — | PA |