Formoterol

2 Ml — Solution

Also known as: Perforomist Formoterol 20 Mcg/2 Ml Inhalation 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: 1 hour, 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 3 - Non-Preferred	—	—	✓	QL

7 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 1 hour, 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
HealthSpring Preferred Plus (HMO) via Perforomist	Tier 5 - Specialty	✓	—	✓ 120 per 30 days	PA \| QL
HealthSpring Preferred Select (HMO) via Perforomist	Tier 5 - Specialty	✓	—	✓ 120 per 30 days	PA \| QL
HealthSpring Preferred Savings (HMO) via Perforomist	Tier 5 - Specialty	✓	—	✓ 120 per 30 days	PA \| QL
HealthSpring True Choice (PPO) via Perforomist	Tier 5 - Specialty	✓	—	✓ 120 per 30 days	PA \| QL
HealthSpring TotalCare (HMO D-SNP) via Perforomist	Tier 5 - Specialty	✓	—	✓ 120 per 30 days	PA \| QL
HealthSpring TotalCare Plus (HMO D-SNP) via Perforomist	Tier 5 - Specialty	✓	—	✓ 120 per 30 days	PA \| QL
HealthSpring Preferred (HMO) via Perforomist	Tier 5 - Specialty	✓	—	✓ 120 per 30 days	PA \| QL

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 1 hour, 13 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Perforomist	Non-Preferred	—	✓	—	ST
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	✓	—	ST