ampicillin & sulbactam sodium for
Injection
Also known as:
ampicillin & sulbactam sodium for inj 1.5 (1-0.5) gm
ampicillin & sulbactam sodium for inj 3 (2-1) gm
ampicillin & sulbactam sodium for inj 1.5 (1-0.5)
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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.
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 2 - Non-Preferred Generic | — | — | — | None |