Gonal-f RFF Rediject Subcutaneous
Generic: Follitropin Alfa
300 UNIT/0.5ML — Solution
Also known as:
Gonal-f RFF Rediject Subcutaneous Solution Pen-injector
Follitropin Alfa
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
41 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-F |
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 Gonal F |
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 Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal F |
Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 5 - Specialty | ✓ | — | — | PA |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | 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 Gonal-f RFF Subcutaneous |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-f RFF Subcutaneous |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-f RFF Subcutaneous |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-f RFF Subcutaneous |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-f RFF Subcutaneous |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-f RFF Subcutaneous |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Gonal-f RFF Subcutaneous |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-f RFF Subcutaneous |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-f RFF Subcutaneous |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-f RFF Subcutaneous |
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 Gonal F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Gonal F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
Cigna
40 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze 6500 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze 5500 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver 5000 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver 3600 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver 3000 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze CMS Standard
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver CMS Standard
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Gold CMS Standard
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect myDiabetesCare Bronze
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect myDiabetesCare Silver
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Gold 1500 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze RD 5000 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze RD CMS Standard
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver RD 3500 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver RD 5000 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver RD CMS Standard
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver RD 2200 Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Gold RD CMS Standard
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Gonal-F |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze 6500 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze 5500 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver 5000 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver 3600 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver 3000 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze CMS Standard
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver CMS Standard
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Gold CMS Standard
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect myDiabetesCare Bronze
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect myDiabetesCare Silver
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Gold 1500 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze RD 5000 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Bronze RD CMS Standard
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver RD 3500 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver RD 5000 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver RD CMS Standard
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Silver RD 2200 Indiv Med Deductible
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
|
Connect Gold RD CMS Standard
via Gonal-F Rff Redi-Ject |
Tier 5 - Specialty | ✓ | — | — | PA |
TRICARE
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
TRICARE Uniform Formulary 2026
via Gonal-F |
Tier 2 - Brand Formulary | ✓ | — | ✓ GONAL-F 450 UNITS VIAL TO BE DISPENSED AT A MAX QUANTITY OF 8 UNITS IN 22 DAYS OR 8 UNITS IN 23 DAYS | PA | QL PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED; Quantity limit |
|
TRICARE Uniform Formulary 2026
via Gonal-F Rff Redi-Ject |
Tier 2 - Brand Formulary | ✓ | — | ✓ 1270/99001/88156 INJ INFERTILITY (MSL2887) DOD: REJECT P/A | PA | QL PA: 1270/48001/90693 PA DRUGS, DOD PA REQUIRED; Quantity limit |