Tyruko

Generic: natalizumab-sztn

300 MG

Integrin Receptor Antagonist

Also known as: natalizumab-sztn

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Oct 13, 2026  ·  Checked: 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Elite + PCP Saver Plus Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic 4700 | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic Tier 5 - Specialty ✓ — ✓ PA | QL
Secure Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic 4700 Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple PCP Saver Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Diabetes Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Classic Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic Standard | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic Standard | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Classic Standard | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Chronic Care CKM | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Secure | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Diabetes | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple PCP Saver | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Diabetes | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Chronic Care CKM | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010074 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010075 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010076 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010077 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010078 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010079 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010080 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010081 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010082 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010083 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010084 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010085 Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus with Adult Dental & Vision Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Diabetes Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Core Plan Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Core Plan | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Diabetes with Adult Dental & Vision Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010108 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010109 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010110 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010111 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010112 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010113 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010114 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010115 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010116 Tier 5 - Specialty ✓ — ✓ PA | QL
69803NC0010117 Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
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