Tolectin Ds
Generic: tolmetin sodium
400MG — Capsule
NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS)
Also known as:
TOLECTIN DS CAPS 400MG
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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
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via tolmetin sodium |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Standard Option 2026
via tolmetin sodium |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via tolmetin sodium |
Tier 1 - Generic | — | — | — | None |
| BCBS Federal Standard Option 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
| BCBS Federal Basic Option 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Bronze CMS Standard
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3000 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 6500 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver CMS Standard
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD CMS Standard
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold CMS Standard
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD CMS Standard
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold RD CMS Standard
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Silver
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 2200 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold 1500 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Bronze
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 5500 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 6000 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3500 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 5000 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 3500 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 4400 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 5000 Indiv Med Deductible
via tolmetin sodium |
Tier 2 - Generic | — | — | — | None |
NC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via tolmetin sodium |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via tolmetin sodium |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via tolmetin sodium |
Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |