dicyclomine hcl

10 mg, 20 mg — Capsule

ULCER DRUGS

Also known as: dicyclomine hcl oral capsule dicyclomine hcl oral solution 10 dicyclomine hcl oral tablet 20 mg dicyclomine hcl cap 10 mg dicyclomine hcl tab 20 mg dicyclomine hcl caps 10mg; soln 10mg/5ml; tabs 20mg dicyclomine hcl soln 10mg/ml dicyclomine hcl caps 10mg; soln 10mg/5ml; dicyclomine hcl caps 10mg; soln 10mg/5ml; tabs 20mg, 40mg

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: Apr 1, 2026  ·  Checked: 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 1 - Generic None
BCBS Federal Focus 2026 Tier 1 - Generic None
BCBS Federal Standard Option 2026 Tier 1 - Generic None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026 Tier 1 - Lowest Cost Generic None
BCBSNC Blue Care 2026 Tier 1 - Lowest Cost Generic None
BCBSNC Blue Value 2026 Tier 1 - Lowest Cost Generic None
BCBSNC Blue Advantage 2026 Tier 1 - Lowest Cost Generic None
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 1 - Lowest Cost Generic None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 2 - Non-Preferred Generic None
NC State Health Plan - HDHP 2026 Tier 2 - Non-Preferred Generic None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 2 - Non-Preferred Generic None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Basic Core Formulary None
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026 Tier 2 - Lower Cost None
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