Xyrem

Generic: oxybate

500MG — Solution

Also known as: XYREM SOLN 500MG/ML Xyrem Oral Solution

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

4 plans

Source: CMS QHP JSON · Formulary date: Sep 22, 2026 · Checked: 14 hours, 42 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals	Tier 5 - Specialty	✓	—	—	PA

2 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 14 hours, 42 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Standard Option 2026	Tier 3 - Non-Preferred Brand	✓	—	—	PA

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 14 hours, 42 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Not Covered	—	—	—	None