Acetaminophen-Codeine

Generic: acetaminophen with codeine phosphate

12.5 Ml — Tablet

Also known as: acetaminophen-codeine oral acetaminophen-codeine oral tablet Acetaminophen-Codeine 120-12 Mg/5 Ml Oral Solution Acetaminophen-Codeine 300-30 Mg/12.5 Ml Oral Solution

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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.

Cigna

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 19 hours, 3 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 1 - Generic	—	—	—	None

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 19 hours, 3 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via acetaminophen with codeine phosphate	Tier 1 - Basic Core Formulary	—	—	—	None

UnitedHealthcare

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 19 hours, 3 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026	Unknown	—	—	✓	QL