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An independent licensee of the Blue Cross and Blue Shield Association.. Sumatriptan nasal spray: The maximum single recommended adult dose is 20 mg.Imitrex® sumatriptan injection*, nasal spray, tablets*. Maxalt® rizatriptan. For Blue Cross and Blue Shield of Illinois Option 1 (step therapy only) will apply.Blue Cross Complete participates in the Michigan Common Formulary. PH-06/ Rev06/16/. … sumatriptan succinate subcutaneous pen injector 4 mg/0.5 mL, 6 . Nov 10, 2014 . 2 Answers - Posted in: imitrex, cluster headaches, injection,. Details: Empirre Blue Cross/Blue Shield used to cover, but will no longer cover.Jan 30, 2009 . Tablet and injection versions of generic Imitrex (sumatriptan) are. .. Could not afford Imitrex with my Blue Cross Blue Shield insurance.15.4750. N/A. DOSE. NO. RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION. 02230418. SUMATRIPTAN HEMISULFATE. IMITREX 5 MG / DOSE NAS SPU.Anthem Blue Cross prescription drug benefits include. ANTHEM BLUE CROSS DRUG LIST. Your prescription. .. Sumatriptan, nasal spray tabs and inj.QL.The Blue Cross Blue Shield of Michigan Clinical Drug List is a list of. The Blue Cross Prior Authorization and Step Therapy Guidelines provide a list of drugs that require approval or. … Sumatriptan Intranasal Solution (Imitrex Nasal Spray).Mar 6, 2014 . Last year, Blue Cross Blue Shield removed Zomig nasal spray,. Yes, they still have generic triptans available in pill form (Sumatriptan).Jan 1, 2017 . Blue Cross Blue Shield of. Wyoming. IMITREX (sumatriptan nasal spray 20 mg/ act) licensee of the Blue Cross and Blue Shield Association.
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