ampicillin & sulbactam sodium for iv
Solution
Also known as:
ampicillin & sulbactam sodium for iv soln 1.5 (1- 0.5) gm
ampicillin & sulbactam sodium for iv soln 3 (2-1) gm
ampicillin & sulbactam sodium for iv soln 15 (10- 5) gm
ampicillin & sulbactam sodium for iv soln 1.5 (1-
ampicillin & sulbactam sodium for iv soln 3 (2-1)
ampicillin & sulbactam sodium for iv soln 15 (10-
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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 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 1 - Preferred Generic | — | — | — | None |