Sapropterin

100 Mg — Powder

Also known as: Sapropterin 100 Mg Powder Packet Sapropterin 500 Mg Powder Packet Sapropterin 100 Mg Tablet

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: 3 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 4 - Specialty	✓	—	— Specialty Pharmacy Required	PA