dihydrocodeine-acetaminophen-caffeine

Tablet

Also known as: Panlor SS

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

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 9 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Non-Preferred	✓	—	—	PA