Mesalamine 4 Gm/60 Ml

60 Ml — Enema

Also known as: Mesalamine 4 Gm/60 Ml Enema Mesalamine 4 Gm/60 Ml Enema Kit

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, 45 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 3 - Non-Preferred	—	—	—	None