Medication Lookup

The results below have been sorted using a 2-tier plan. For the most accurate search results, check your plan details and choose another tier plan from the drop-down menu near the search bar.

XULTOPHY

THERAPEUTIC CLASS: Insulin

100U-3.6MG/ML PEN

Not Covered by a 3-Tier Plan

Learn more about tiers.

Note Title

Quality Care Dosing

Definition

To ensure safety and effectiveness, this medication, which is covered through the pharmacy benefit, has quantity and dosage limits that are recommended by the Food and Drug Administration (FDA). Review the Quality Care Dosing Guidelines in the Important Information section to learn more.
Note Title

Exceptions To Non Covered Medications

Definition

Your doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
Note Title

Prior Authorization Required

Definition

This medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.

Covered Alternative Medications

Other Sites

Medication Lookup

100U-3.6MG/ML PEN

Prior Authorization Forms

Important Information

Specialty Pharmacy

Alternatives to Opioids

For Federal Employee Program Members

Eligible Medicare Members

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