alprostadil

500mcg — Solution

Also known as: alprostadil soln 500mcg/ml

Coverage by Insurer

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

Cigna

20 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 5 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Bronze CMS Standard via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Gold CMS Standard via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze RD CMS Standard via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Gold RD CMS Standard via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect myDiabetesCare Silver via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver RD 2200 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Gold 1500 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect myDiabetesCare Bronze via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze 5500 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze RD 6000 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver 3500 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze RD 5000 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver RD 3500 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze 7000 HSA Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver 4400 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver RD 5000 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver 3000 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze 6500 Indiv Med Deductible via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver CMS Standard via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver RD CMS Standard via EDEX	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL

NC State Health Plan

3 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 5 hours, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	—	—	—	None