Acetaminophen-Caffeine-Dihydrocodeine

320.5-30 Mg — Capsule

Also known as: acetaminophen-caffeine-dihydrocodeine cap 320.5-30-16 mg Acetaminophen-Caffeine-Dihydrocodeine 320.5-30 Mg Capsule acetaminophen-caffeine-dihydrocodeine cap

Compare Prices

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

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 11 hours, 18 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 1 - Generic	—	—	✓	QL
BCBS Federal Basic Option 2026	Tier 1 - Generic	—	—	✓	QL
BCBS Federal Focus 2026	Tier 1 - Generic	—	—	✓	QL

Cigna

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 11 hours, 18 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 1 - Generic	✓	—	—	PA

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 11 hours, 18 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	—	—	✓	QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	—	—	✓	QL
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	—	—	✓	QL