butorphanol tartrate

2 MG — Nasal Spray

OPIOID PARTIAL AGONISTS

Also known as: butorphanol tartrate soln 1mg/ml, 2mg/ml butorphanol tartrate soln 10mg/ml
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 4 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Expanded Bronze + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze Tier 2 - Generic ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Standard Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Standard Gold + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Standard Silver + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 2 - Generic ✓ — ✓ PA | QL
Standard Gold with Atrium Health Tier 2 - Generic ✓ — ✓ PA | QL
Standard Silver with Atrium Health Tier 2 - Generic ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health Tier 2 - Generic ✓ — ✓ PA | QL
Complete Gold with Atrium Health Tier 2 - Generic ✓ — ✓ PA | QL
Focused Silver with Atrium Health Tier 2 - Generic ✓ — ✓ PA | QL
Elite Bronze with Atrium Health Tier 2 - Generic ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health Tier 2 - Generic ✓ — ✓ PA | QL
Standard Gold Tier 2 - Generic ✓ — ✓ PA | QL
Standard Silver Tier 2 - Generic ✓ — ✓ PA | QL
Standard Expanded Bronze Tier 2 - Generic ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options Tier 2 - Generic ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 4 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026 Tier 1 - Generic — — ✓ QL
BCBS Federal Basic Option 2026 Tier 1 - Generic — — ✓ QL
BCBS Federal Focus 2026 Tier 1 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 4 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 10 per 28 days QL
Wellcare Simple (HMO-POS) Tier 2 - Generic — — ✓ 10 per 28 days QL
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic — — ✓ 5 per 30 days QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic — — ✓ 5 per 30 days QL
Troy Medicare (HMO) Tier 2 - Generic — — ✓ 5 per 30 days QL
Wellcare Simple Open (PPO) Tier 2 - Generic — — ✓ 10 per 28 days QL
Wellcare Giveback Open (PPO) Tier 2 - Generic — — ✓ 10 per 28 days QL
DEVOTED CORE 001 NC (HMO) Tier 3 - Preferred Brand — — ✓ 10 per 30 days QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 10 per 30 days QL
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 10 per 30 days QL
DEVOTED GIVEBACK 002 NC (HMO) Tier 3 - Preferred Brand — — ✓ 10 per 30 days QL
DEVOTED GIVEBACK 012 NC (HMO) Tier 3 - Preferred Brand — — ✓ 10 per 30 days QL
Alignment Health Platinum (HMO) Tier 3 - Preferred Brand — — ✓ 48 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 48 per 30 days QL
Alignment Health smartHMO (HMO) Tier 3 - Preferred Brand — — ✓ 48 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 48 per 30 days QL
Alignment Health Platinum Select (HMO) Tier 3 - Preferred Brand — — ✓ 48 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 3 - Preferred Brand — — ✓ 48 per 30 days QL
Alignment Health AVA (PPO) Tier 3 - Preferred Brand — — ✓ 48 per 30 days QL
Aetna Medicare Value Plus (HMO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Dual (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Blue Medicare Choice (HMO) Tier 4 - Non-Preferred — — ✓ 48 per 30 days QL
Blue Medicare Enhanced (HMO-POS) Tier 4 - Non-Preferred — — ✓ 48 per 30 days QL
Blue Medicare Essential Plus (HMO-POS) Tier 4 - Non-Preferred — — ✓ 48 per 30 days QL
Wellcare Dual Liberty Open (PPO D-SNP) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
Wellcare Assist Open (PPO) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
Wellcare Dual Access (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
Blue Medicare PPO Enhanced (PPO) Tier 4 - Non-Preferred — — ✓ 48 per 30 days QL
HealthSpring Preferred Plus (HMO) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
HealthSpring Preferred Savings (HMO) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
HealthSpring Preferred Select (HMO) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
HealthSpring Preferred (HMO) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
HealthSpring TotalCare Plus (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
HealthSpring TotalCare (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
HealthSpring True Choice (PPO) Tier 4 - Non-Preferred — — ✓ 10 per 28 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Signature Care (HMO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Prime (HMO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Signature Giveback (PPO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Signature Extra (PPO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Aetna Medicare Enhanced (HMO) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Blue Medicare Essential (HMO) Tier 4 - Non-Preferred — — ✓ 48 per 30 days QL
Experience Health Medicare Advantage (HMO) Tier 4 - Non-Preferred — — ✓ 48 per 30 days QL
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 48 per 30 days QL
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 5 per 30 days QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 4 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic ✓ — ✓ PA | QL
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic ✓ — ✓ PA | QL
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic ✓ — ✓ PA | QL
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