Diphen

5 Ml — Tablet

Also known as: Diphen 12.5 Mg/5 Ml Elixir Diphen 12.5 Mg/5 Ml Oral Solution

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

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 9 hours, 8 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 3 - Non-Preferred	—	—	—	None