Vimizim

Generic: elosulfase alfa

5MG/5ML — Solution

Also known as: VIMIZIM SOLN 5MG/5ML

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

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 18 hours, 58 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA
BCBS Federal Basic Option 2026	Tier 4 - Preferred Specialty	✓	—	—	PA

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 18 hours, 57 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	—	PA
NC State Health Plan - HDHP 2026	Tier 6 - Non-Preferred Brand Specialty	✓	—	—	PA