Hep Sod/D5W

Injection

(base equiv)

Also known as: HEP SOD/D5W INJ 100/ML HEP SOD/D5W INJ 20000UNT HEP SOD/D5W INJ 25000UNT

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: 4 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered None
NC State Health Plan - HDHP 2026 Not Covered None
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