guaifenesin-codeine

10 mg/5ml — Solution

Also known as: guaifenesin-codeine soln 100-10 mg/5ml

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

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 7 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	✓	—	—	PA
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	✓	—	—	PA
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	✓	—	—	PA

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 7 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026	Unknown	✓	—	✓	PA \| QL