Aminophylline

500 MG — Solution

(base equiv)

Also known as: AMINOPHYLLINE SOLN 25MG/ML

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 15 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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
Source: CMS QHP JSON  ·  Checked: 15 hours, 21 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Simple PCP Saver Tier 2 - Generic None
Gold Elite Saver Plus Tier 2 - Generic None
Silver Simple Diabetes Tier 2 - Generic None
Secure | with Atrium Health Tier 2 - Generic None
Bronze Classic 4700 | with Atrium Health Tier 2 - Generic None
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 2 - Generic None
Silver Classic | with Atrium Health Tier 2 - Generic None
Silver Simple Diabetes | with Atrium Health Tier 2 - Generic None
Silver Simple PCP Saver | with Atrium Health Tier 2 - Generic None
Gold Elite Saver Plus | with Atrium Health Tier 2 - Generic None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic None
Bronze Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic None
Silver Classic Tier 2 - Generic None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic None
Bronze Classic Standard Tier 2 - Generic None
Silver Classic Standard Tier 2 - Generic None
Gold Classic Standard Tier 2 - Generic None
Bronze Classic Standard | with Atrium Health Tier 2 - Generic None
Silver Classic Standard | with Atrium Health Tier 2 - Generic None
Gold Classic Standard | with Atrium Health Tier 2 - Generic None
Bronze Elite + PCP Saver Plus Tier 2 - Generic None
Silver Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 2 - Generic None
AIAN Cost Share Tier 2 - Generic None
AIAN Cost Share | with Atrium Health Tier 2 - Generic None
Bronze Simple Diabetes | with Atrium Health Tier 2 - Generic None
Secure Tier 2 - Generic None
Bronze Classic 4700 Tier 2 - Generic None
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