Sustol

10MG/0.4ML — Prefilled Syringe

Also known as: SUSTOL PRSY 10MG/0.4ML

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

2 plans

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 6 hours, 7 minutes ago

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

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 6 hours, 7 minutes ago

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