codeine sulfate
15MG, 60MG — Tablet
Also known as:
CODEINE SULFATE TABS 15MG, 60MG
codeine sulfate tabs 30mg
codeine sulfate tab 30 mg
Codeine Sulfate 15 Mg Tablet
Codeine Sulfate 30 Mg Tablet
Codeine Sulfate 60 Mg Tablet
Codeine Sulfate 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.
Ambetter (Centene)
29 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Complete Gold | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze | Tier 2 - Generic | — | — | — | None |
| Elite Bronze | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Gold | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | — | None |
| Standard Silver | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | — | None |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 2 - Generic | ✓ | — | ✓ | PA | QL |
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | ✓ | QL |
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | ✓ | QL |
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | ✓ | QL |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Advantage 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Value 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Care 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Local 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Silver 3000 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze 6500 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver RD CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Gold CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze 5500 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver 3500 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver 4400 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze RD CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Gold RD CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Bronze CMS Standard | Tier 2 - Generic | ✓ | — | — | PA |
| Connect myDiabetesCare Silver | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect Gold 1500 Indiv Med Deductible | Tier 2 - Generic | ✓ | — | — | PA |
| Connect myDiabetesCare Bronze | Tier 2 - Generic | ✓ | — | — | PA |
Medicare Part D
32 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| 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 |
| 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 |
| Blue Medicare Choice (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Dual (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Value Plus (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Prime (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Signature Care (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Enhanced (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Signature Extra (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Signature Giveback (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Blue Medicare PPO Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Blue Medicare Essential Plus (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Blue Medicare Enhanced (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Blue Medicare Essential (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Experience Health Medicare Advantage (HMO) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 180 per 30 days | QL |
NC Medicaid PDL
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 1 - Preferred Generic | ✓ | — | ✓ | PA | QL |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Silver Simple Diabetes | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple PCP Saver | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Gold Elite Saver Plus | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Simple Diabetes | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Secure | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| AIAN Cost Share | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| AIAN Cost Share | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple Diabetes | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Gold Elite Saver Plus | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple PCP Saver | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Classic 4700 | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Secure | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Classic | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Gold Classic Standard | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Classic Standard | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Classic Standard | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Gold Classic Standard | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Classic Standard | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Classic Standard | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Classic 4700 | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
| Silver Classic | with Atrium Health | Tier 3 - Preferred Brand | — | — | ✓ | QL |
UnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Gold Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | ✓ | QL |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 1 - Preferred Generic | — | — | ✓ | QL |