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
GoodRx Compare Prices

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Checked: 5 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Gonal F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Gonal F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + No Referrals
via Gonal F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + No Referrals
via Gonal F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Gonal F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Premier + 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 + No Referrals
via Gonal F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Premier + No Referrals
via Gonal F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Gonal F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Premier + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Essential + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + No Referrals
via Gonal-f RFF Subcutaneous 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Gonal-f RFF Subcutaneous 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Essential + No Referrals
via Gonal-f RFF Subcutaneous 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Gonal-f RFF Subcutaneous 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Gonal-f RFF Subcutaneous 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Gonal-f RFF Subcutaneous 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Premier + No Referrals
via Gonal-f RFF Subcutaneous 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Gonal-f RFF Subcutaneous 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + 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 Bronze Essential + No Referrals
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + No Referrals
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Essential + 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 Off-Marketplace Low + No Referrals
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Premier + No Referrals
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + No Referrals
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Essential + No Referrals
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Premier + No Referrals
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + No Referrals
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + No Referrals
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 5 hours, 25 minutes ago
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 Silver RD 5000 Indiv Med Deductible
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
Connect Silver 3500 Indiv Med Deductible
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 Silver RD 3500 Indiv Med Deductible
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 myDiabetesCare Silver
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 Bronze RD 5000 Indiv Med Deductible
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
Connect Bronze 6500 Indiv Med Deductible
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
Connect Silver 4400 Indiv Med Deductible
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
Connect myDiabetesCare Bronze
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 RD 6000 Indiv Med Deductible
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Bronze 7000 HSA 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 3500 Indiv Med Deductible
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Silver RD 2200 Indiv Med Deductible
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Silver RD 3500 Indiv Med Deductible
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Gold 1500 Indiv Med Deductible
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect myDiabetesCare Silver
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Bronze 5500 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 6500 Indiv Med Deductible
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Silver 4400 Indiv Med Deductible
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect myDiabetesCare Bronze
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Silver 3000 Indiv Med Deductible
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Silver RD CMS Standard
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
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 Bronze RD CMS Standard
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 RD CMS Standard
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Gold RD 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 Bronze RD CMS Standard
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Bronze CMS Standard
via Gonal-F 		Tier 5 - Specialty ✓ — — PA
Connect Bronze RD 6000 Indiv Med Deductible
via Gonal-F Rff Redi-Ject 		Tier 5 - Specialty ✓ — — PA
Something not right?