sumatriptan injection kit / refill

Prefilled Syringe

Antimigraine Agents — Quantity limits apply to all triptans

Also known as: Imitrex

Coverage by Insurer

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

Ambetter (Centene)

34 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 4 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Focused Silver with Atrium Health via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze with Atrium Health via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver with Atrium Health via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold with Atrium Health via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Focused Silver with Atrium Health + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Complete Gold with Atrium Health + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Silver with Atrium Health + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Signature Gold with Atrium Health + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Streamlined Silver with Atrium Health via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Streamlined Silver via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Clear Silver with $0 Insulin Options + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via Imitrex	Tier 3 - Preferred Brand	—	—	✓	QL

Blue Cross Blue Shield Federal

2 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 4 hours, 26 minutes ago

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

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 4 hours, 26 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Care 2026 via Imitrex	Tier 1 - Lowest Cost Generic	—	—	✓	QL
BCBSNC Blue Home with UNC Health Alliance 2026 via Imitrex	Tier 1 - Lowest Cost Generic	—	—	✓	QL
BCBSNC Blue Advantage 2026 via Imitrex	Tier 1 - Lowest Cost Generic	—	—	✓	QL
BCBSNC Blue Local 2026 via Imitrex	Tier 1 - Lowest Cost Generic	—	—	✓	QL
BCBSNC Blue Value 2026 via Imitrex	Tier 1 - Lowest Cost Generic	—	—	✓	QL

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 4 hours, 26 minutes ago

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

NC State Health Plan

3 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 4 hours, 26 minutes ago

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