Promethazine

Generic: Promethegan ( and )

12.5 Mg — Suppository

Also known as: Promethazine 12.5 Mg Suppository Promethazine 25 Mg Suppository Promethazine 12.5 Mg/10 Ml Syrup Promethazine 12.5 Mg Tablet Promethazine 25 Mg Tablet Promethazine 50 Mg Tablet Promethazine 6.25 Mg/5 Ml Syrup

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Coverage by Insurer

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

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 7 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026 via Promethegan Suppository (12.5 mg and 25 mg)	Tier 1 - Generic	—	—	—	None
BCBS Federal Basic Option 2026 via Promethegan Suppository (12.5 mg and 25 mg)	Tier 1 - Generic	—	—	—	None
BCBS Federal Focus 2026 via Promethegan Suppository (12.5 mg and 25 mg)	Tier 1 - Generic	—	—	—	None

Cigna

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 7 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 1 - Generic	—	—	—	None

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 7 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Promethegan Suppository (12.5 mg and 25 mg)	Preferred	—	—	—	None

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 7 hours, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 via Promethegan Suppository (12.5 mg and 25 mg)	Tier 2 - Non-Preferred Generic	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Promethegan Suppository (12.5 mg and 25 mg)	Tier 2 - Non-Preferred Generic	—	—	—	None
NC State Health Plan - HDHP 2026 via Promethegan Suppository (12.5 mg and 25 mg)	Tier 2 - Non-Preferred Generic	—	—	—	None