caffeine citrate

3 Ml — Tablet

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ ANOREXIANTS

Also known as: caffeine citrate oral caffeine citrate soln 20mg/ml, 60mg/3ml caffeine citrate oral soln 60 mg/3ml Caffeine Citrate 60 Mg/3 Ml Oral Solution

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 14 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via 10 Mg/Ml Base Equiv
Tier 2 - Medium Cost Generic/Brand None
BCBSNC Blue Home with UNC Health Alliance 2026
via 10 Mg/Ml Base Equiv
Tier 2 - Medium Cost Generic/Brand None
BCBSNC Blue Local 2026
via 10 Mg/Ml Base Equiv
Tier 2 - Medium Cost Generic/Brand None
BCBSNC Blue Care 2026
via 10 Mg/Ml Base Equiv
Tier 2 - Medium Cost Generic/Brand None
BCBSNC Blue Value 2026
via 10 Mg/Ml Base Equiv
Tier 2 - Medium Cost Generic/Brand None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 21 hours, 14 minutes ago
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
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 21 hours, 14 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 1 - Preferred Generic None
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 1 - Preferred Generic None
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 1 - Preferred Generic None
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 1 - Preferred Generic None
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 1 - Preferred Generic None
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 1 - Preferred Generic None
UHC Gold Standard (No Referrals) Tier 1 - Preferred Generic None
UHC Silver Standard (No Referrals) Tier 1 - Preferred Generic None
UHC Bronze Standard (No Referrals) Tier 1 - Preferred Generic None
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 1 - Preferred Generic None
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 1 - Preferred Generic None
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 1 - Preferred Generic None
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 1 - Preferred Generic None
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