butalbital-apap-caffeine
40 MG — Tablet
Opioid Analgesics, Short-acting
Also known as:
butalbital-apap-caffeine oral
butalbital-apap-caffeine oral tablet
Butalbital-APAP-Caffeine Oral Capsule
Butalbital-APAP-Caffeine Oral Tablet
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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.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals | Tier 2 - Generic | — | — | ✓ | QL |
Medicare Part D
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | ✓ | — | — | PA |
| Troy Medicare (HMO) | Tier 2 - Generic | ✓ | — | — | PA |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 180 per 30 days | QL |
| Alignment Health Platinum Select (HMO) | Tier 3 - Preferred Brand | — | — | ✓ 180 per 30 days | QL |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 180 per 30 days | QL |
| Alignment Health AVA (PPO) | Tier 3 - Preferred Brand | — | — | ✓ 180 per 30 days | QL |
| Alignment Health Platinum (HMO) | Tier 3 - Preferred Brand | — | — | ✓ 180 per 30 days | QL |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 3 - Preferred Brand | — | — | ✓ 180 per 30 days | QL |
| Alignment Health smartHMO (HMO) | Tier 3 - Preferred Brand | — | — | ✓ 180 per 30 days | QL |