Sprix

Generic: ketorolac

15.75MG — Solution

Also known as: SPRIX SOLN 15.75MG/SPRAY

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

6 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 18 hours, 57 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026 via Acular	Tier 3 - Non-Preferred Brand	—	—	—	None
BCBS Federal Standard Option 2026	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Standard Option 2026 via Acular	Tier 3 - Non-Preferred Brand	—	—	—	None
BCBS Federal Standard Option 2026 via Acuvail	Tier 3 - Non-Preferred Brand	—	—	—	None
BCBS Federal Basic Option 2026	Tier 3 - Non-Preferred Brand	✓	—	—	PA
BCBS Federal Basic Option 2026 via Acuvail	Tier 3 - Non-Preferred Brand	—	—	—	None

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 18 hours, 57 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Advantage 2026 via Acular	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Home with UNC Health Alliance 2026 via Acular	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Local 2026 via Acular	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Care 2026 via Acular	Tier 1 - Lowest Cost Generic	—	—	—	None
BCBSNC Blue Value 2026 via Acular	Tier 1 - Lowest Cost Generic	—	—	—	None

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 18 hours, 57 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026 via Ketorolac	Tier 1 - Generic	—	—	✓	QL

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 18 hours, 57 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Ketorolac	Non-Preferred	—	—	—	None
NC Medicaid Preferred Drug List 2026 via Acuvail	Non-Preferred	—	—	—	None

6 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 18 hours, 57 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Acular	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Acular	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Acular	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026	Not Covered	—	—	—	None