Ustekinumab-ttwe Vial

Prefilled Syringe

Cytokine And Cam Antagonists

Also known as: Pyzchiva
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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.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 9 hours, 38 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Streamlined Silver with Atrium Health
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Silver + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Gold + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Silver with Atrium Health + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Gold with Atrium Health + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Streamlined Silver
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced CHF Heart Care Silver $0 Rx Options
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Expanded Bronze + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Expanded Bronze
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Silver
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Gold
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Expanded Bronze with Atrium Health
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Silver with Atrium Health
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Signature Gold with Atrium Health
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 9 hours, 38 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via Pyzchiva 		Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Standard Option 2026
via Pyzchiva 		Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Basic Option 2026
via Pyzchiva 		Tier 4 - Preferred Specialty ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 9 hours, 38 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP)
via Pyzchiva 		Tier 1 - Preferred Generic ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Signature (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Signature Giveback (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Signature (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Alignment Health AVA (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Healthy Blue + Medicare (HMO-POS D-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
DEVOTED CHOICE 001 NC (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED CHOICE 003 NC (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED CHOICE 005 NC (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED CHOICE 008 NC (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Signature (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Dual (HMO D-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Signature (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Value Plus (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Prime (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Signature Care (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Chronic Care (HMO C-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Enhanced (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Blue Medicare PPO Enhanced (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Blue Medicare Essential Plus (HMO-POS)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Blue Medicare Enhanced (HMO-POS)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Blue Medicare Choice (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Blue Medicare Essential (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Experience Health Medicare Advantage (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Alignment Health Platinum (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Alignment Health NC Duals (HMO-POS D-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Alignment Health smartHMO (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Alignment Health Platinum Select (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
DEVOTED CORE 001 NC (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED GIVEBACK 002 NC (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED DUAL 009 NC (HMO D-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED GIVEBACK 012 NC (HMO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Signature (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Enhanced (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Enhanced (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Signature Extra (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Aetna Medicare Signature (PPO)
via Pyzchiva 		Tier 5 - Specialty ✓ — ✓ 1 per 28 days PA | QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 9 hours, 38 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred ✓ ✓ — PA | ST
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 9 hours, 38 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via Pyzchiva 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Pyzchiva 		Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via Pyzchiva 		Not Covered — — — None
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