famotidine tablet

Suspension

Also known as: Pepcid

Coverage by Insurer

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

Ambetter (Centene)

34 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 8 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Complete Gold via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Enhanced Asthma/COPD Care Silver $0 Rx Options via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Everyday Bronze via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Elite Bronze via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Clear Silver with $0 Insulin Options via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Expanded Bronze via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Silver via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Gold via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Everyday Bronze with Atrium Health via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Elite Bronze with Atrium Health via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Focused Silver with Atrium Health via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Complete Gold with Atrium Health via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Expanded Bronze with Atrium Health via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Silver with Atrium Health via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Gold with Atrium Health via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Complete Gold + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Everyday Bronze + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Elite Bronze + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Everyday Bronze with Atrium Health + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Elite Bronze with Atrium Health + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Focused Silver with Atrium Health + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Complete Gold with Atrium Health + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Expanded Bronze + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Silver + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Gold + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Silver with Atrium Health + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Signature Gold with Atrium Health + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Enhanced CHF Heart Care Silver $0 Rx Options via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Streamlined Silver with Atrium Health via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Streamlined Silver via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Clear Silver with $0 Insulin Options + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental via Pepcid	Tier 4 - Non-Preferred	—	—	—	None

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Oct 1, 2026 · Checked: 8 hours, 38 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Preferred	—	—	—	None