Follistim Aq
Generic: follitropin beta
300 Unit — Cartridge
Also known as:
FOLLISTIM AQ SOLN 300UNT/0.36ML, 600UNT/0.72ML, 900UNT/1.08ML
Follistim Aq 300 Unit Cartridge
Follistim Aq 600 Unit Cartridge
Follistim Aq 900 Unit Cartridge
FOLLISTIM AQ SOLN 300UNT/0.36ML,
follitropin beta
Follistim AQ Subcutaneous Solution
Compare Prices
Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
AmeriHealth Caritas NC
11 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 2 - Preferred Brand | ✓ | — | — | PA |
| BCBS Federal Basic Option 2026 | Tier 4 - Preferred Specialty | ✓ | — | — | PA |
| BCBS Federal Standard Option 2026 | Tier 4 - Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Value 2026 | Tier 4 - Higher Cost Brand | — | — | ✓ | QL |
| BCBSNC Blue Care 2026 | Tier 4 - Higher Cost Brand | — | — | ✓ | QL |
| BCBSNC Blue Local 2026 | Tier 4 - Higher Cost Brand | — | — | ✓ | QL |
| BCBSNC Blue Advantage 2026 | Tier 4 - Higher Cost Brand | — | — | ✓ | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 4 - Higher Cost Brand | — | — | ✓ | QL |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Bronze 6500 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Bronze 5500 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Silver 5000 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Silver 3600 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Silver 3000 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Bronze CMS Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Silver CMS Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Gold CMS Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect myDiabetesCare Bronze | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect myDiabetesCare Silver | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Gold 1500 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Bronze RD CMS Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Silver RD CMS Standard | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 5 - Specialty | ✓ | — | — | PA |
| Connect Gold RD CMS Standard | Tier 5 - Specialty | ✓ | — | — | PA |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 5 - Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 5 - Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 5 - Preferred Brand Specialty | ✓ | — | ✓ | PA | QL |
UnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Bronze Standard (HSA, $0 Insulin, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |
|
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals)
via Follistim |
Tier 5 - Specialty | ✓ | — | — | PA |