Zilbrysq

Generic: zilucoplan

16.6MG/0.416ML, 23MG/0.574ML, 32.4MG/0.81ML — Prefilled Syringe

Also known as: zilucoplan ZILBRYSQ SOSY 16.6MG/0.416ML, 23MG/0.574ML, 32.4MG/0.81ML

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: 3 hours, 34 minutes ago

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

3 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 3 hours, 34 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Troy Medicare (HMO)	Tier 5 - Specialty	✓	—	—	PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 5 - Specialty	✓	—	✓ 22.68 per 28 days	PA \| QL