Imitrex Statdose System Soaj

4MG/0.5ML, 6MG/0.5ML — Auto-Injector

Also known as: IMITREX STATDOSE SYSTEM SOAJ 4MG/0.5ML, 6MG/0.5ML IMITREX STATDOSE SYSTEM SOAJ 6MG/0.5ML

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

2 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 18 hours, 30 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 3 - Non-Preferred Brand	—	—	✓	QL
BCBS Federal Basic Option 2026	Tier 3 - Non-Preferred Brand	—	—	✓	QL

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 18 hours, 30 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 3 - Non-Preferred Brand	✓	—	✓	PA \| QL
NC State Health Plan - HDHP 2026	Tier 3 - Non-Preferred Brand	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 3 - Non-Preferred Brand	✓	—	✓	PA \| QL