bismuth subcitrate

140 MG — Capsule

Tetracycline-class Antimicrobial

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 15 hours, 16 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Alignment Health Platinum (HMO) Tier 4 - Non-Preferred None
Alignment Health NC Duals (HMO-POS D-SNP) Tier 4 - Non-Preferred None
Alignment Health smartHMO (HMO) Tier 4 - Non-Preferred None
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 4 - Non-Preferred None
Alignment Health Platinum Select (HMO) Tier 4 - Non-Preferred None
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 4 - Non-Preferred None
Alignment Health AVA (PPO) Tier 4 - Non-Preferred None
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