Vistogard 10 Gram

Packet

Also known as: Vistogard 10 Gram Packet

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: 11 hours, 21 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 4 - Specialty	—	—	— Limited Distribution; Specialty Pharmacy Required	None