Butalbital Compound-Codeine #3

Capsule

Also known as: Butalbital Compound-Codeine #3 Capsule

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 4 hours, 25 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 2 - Preferred Brand	✓	—	—	PA