codeine phosphate

Solution

Expectorant

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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.
Source: CMS QHP JSON  ·  Formulary date: Oct 13, 2026  ·  Checked: 15 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Silver Simple Diabetes with Adult Dental & Vision | with Atrium Health Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision Tier 2 - Generic — — — None
Bronze Simple Diabetes Tier 2 - Generic — — — None
Silver Core Plan Tier 2 - Generic — — — None
Silver Core Plan | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Diabetes with Adult Dental & Vision Tier 2 - Generic — — — None
69803NC0010108 Tier 2 - Generic — — — None
69803NC0010109 Tier 2 - Generic — — — None
69803NC0010110 Tier 2 - Generic — — — None
69803NC0010111 Tier 2 - Generic — — — None
69803NC0010112 Tier 2 - Generic — — — None
69803NC0010113 Tier 2 - Generic — — — None
69803NC0010114 Tier 2 - Generic — — — None
69803NC0010115 Tier 2 - Generic — — — None
69803NC0010116 Tier 2 - Generic — — — None
69803NC0010117 Tier 2 - Generic — — — None
Bronze Simple Diabetes with Adult Dental & Vision | with Atrium Health Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus Tier 2 - Generic — — — None
Bronze Classic 4700 | with Atrium Health Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 2 - Generic — — — None
Silver Classic Tier 2 - Generic — — — None
Secure Tier 2 - Generic — — — None
Bronze Classic 4700 Tier 2 - Generic — — — None
Silver Simple PCP Saver Tier 2 - Generic — — — None
Silver Simple Diabetes Tier 2 - Generic — — — None
Bronze Classic Standard Tier 2 - Generic — — — None
Silver Classic Standard Tier 2 - Generic — — — None
Gold Classic Standard Tier 2 - Generic — — — None
Bronze Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Silver Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Gold Classic Standard | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Secure | with Atrium Health Tier 2 - Generic — — — None
Silver Classic | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Silver Simple PCP Saver | with Atrium Health Tier 2 - Generic — — — None
Bronze Simple Diabetes | with Atrium Health Tier 2 - Generic — — — None
Bronze Elite + PCP Saver Plus with Adult Dental & Vision | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Chronic Care CKM | with Atrium Health Tier 2 - Generic — — — None
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 2 - Generic — — — None
69803NC0010074 Tier 2 - Generic — — — None
69803NC0010075 Tier 2 - Generic — — — None
69803NC0010076 Tier 2 - Generic — — — None
69803NC0010077 Tier 2 - Generic — — — None
69803NC0010078 Tier 2 - Generic — — — None
69803NC0010079 Tier 2 - Generic — — — None
69803NC0010080 Tier 2 - Generic — — — None
69803NC0010081 Tier 2 - Generic — — — None
69803NC0010082 Tier 2 - Generic — — — None
69803NC0010083 Tier 2 - Generic — — — None
69803NC0010084 Tier 2 - Generic — — — None
69803NC0010085 Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 15 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) Tier 1 - Preferred Generic ✓ — ✓ PA | QL
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