Butalbital-Acetaminophen-Caffeine

50-300-40 Mg — Capsule

Also known as: butalbital-acetaminophen-caffeine cap 50-300- 40 mg butalbital-acetaminophen-caffeine cap 50-325- 40 mg butalbital-acetaminophen-caffeine tab 50-325- 40 mg Butalbital-Acetaminophen-Caffeine 50-300-40 Mg Capsule Butalbital-Acetaminophen-Caffeine 50-325-40 Mg Tablet butalbital-acetaminophen-caffeine cap 50- 300-40 mg butalbital-acetaminophen-caffeine cap 50- 325-40 mg butalbital-acetaminophen-caffeine cap 50-300- butalbital-acetaminophen-caffeine cap 50-325- butalbital-acetaminophen-caffeine tab 50-325-

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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.

Blue Cross Blue Shield Federal

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 1 hour, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 1 - Generic	—	—	✓	QL
BCBS Federal Basic Option 2026	Tier 1 - Generic	—	—	✓	QL
BCBS Federal Focus 2026	Tier 1 - Generic	—	—	✓	QL

Cigna

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 1 hour, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 1 - Generic	—	—	✓	QL

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 1 hour, 53 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	—	—	✓	QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	—	—	✓	QL
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	—	—	✓	QL