EDEX

Generic: alprostadil

10 MCG, 20 MCG, 40 MCG — Kit

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: Oct 15, 2026 · Checked: 20 hours, 8 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver RD 5000 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver RD CMS Standard	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver RD 2200 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Gold RD CMS Standard	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze 6500 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze 5500 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver 5000 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver 3600 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver 3000 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze CMS Standard	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver CMS Standard	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Gold CMS Standard	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect myDiabetesCare Bronze	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect myDiabetesCare Silver	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Gold 1500 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze RD 5000 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze RD 6000 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Bronze RD CMS Standard	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL
Connect Silver RD 3500 Indiv Med Deductible	Tier 4 - Non-Preferred	✓	—	✓	PA \| QL

NC State Health Plan

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 20 hours, 8 minutes ago

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

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Sep 23, 2026 · Checked: 20 hours, 8 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 2 - Brand Formulary	—	—	✓ EDEX (PS 6) TO BE DISP AT A MAX QTY OF 1 UNIT IN 23 DAYS OR 3 UNITS IN 68 DAYS	QL Quantity limit