zelvysia pack

100mg, 500mg

Also known as: zelvysia pack 100mg, 500mg Zelvysia Pack 100mg, 500mg

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

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 20 hours, 43 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 5 - Non-Preferred Specialty	✓	—	—	PA

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 20 hours, 43 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 4 - Specialty Generic	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026	Tier 4 - Specialty Generic	✓	—	—	PA
NC State Health Plan - HDHP 2026	Tier 4 - Specialty Generic	✓	—	—	PA