Hydrocodone/Ibuprofen

Generic: hydrocodone-ibuprofen

ANALGESICS - NARCOTIC

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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Premier + No Referrals
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via hydrocodone-ibuprofen 		Tier 1 - Generic — — ✓ QL
BCBS Federal Focus 2026
via hydrocodone-ibuprofen 		Tier 1 - Generic — — ✓ QL
BCBS Federal Basic Option 2026
via hydrocodone-ibuprofen 		Tier 1 - Generic — — ✓ QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via hydrocodone-ibuprofen 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Local 2026
via hydrocodone-ibuprofen 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Care 2026
via hydrocodone-ibuprofen 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Value 2026
via hydrocodone-ibuprofen 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Home with UNC Health Alliance 2026
via hydrocodone-ibuprofen 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 4 - Higher Cost Brand — — ✓ QL
BCBSNC Blue Local 2026 Tier 4 - Higher Cost Brand — — ✓ QL
BCBSNC Blue Care 2026 Tier 4 - Higher Cost Brand — — ✓ QL
BCBSNC Blue Value 2026 Tier 4 - Higher Cost Brand — — ✓ QL
BCBSNC Blue Advantage 2026 Tier 4 - Higher Cost Brand — — ✓ QL
Source: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Gold CMS Standard
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Bronze CMS Standard
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Silver 3000 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Silver 3600 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Silver 5000 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Bronze 5500 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Bronze 6500 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Bronze 7000 HSA Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Gold RD CMS Standard
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Silver RD 2200 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Silver RD CMS Standard
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Silver RD 5000 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Silver RD 3500 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Bronze RD CMS Standard
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Bronze RD 6000 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Bronze RD 5000 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Gold 1500 Indiv Med Deductible
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect myDiabetesCare Silver
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect myDiabetesCare Bronze
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Connect Silver CMS Standard
via hydrocodone-ibuprofen 		Tier 2 - Generic ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Troy Medicare (HMO)
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via hydrocodone-ibuprofen 		Tier 2 - Generic — — — None
Alignment Health Platinum (HMO)
via hydrocodone-ibuprofen 		Tier 2 - Generic — — ✓ 150 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP)
via hydrocodone-ibuprofen 		Tier 2 - Generic — — ✓ 150 per 30 days QL
Alignment Health smartHMO (HMO)
via hydrocodone-ibuprofen 		Tier 2 - Generic — — ✓ 150 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via hydrocodone-ibuprofen 		Tier 2 - Generic — — ✓ 150 per 30 days QL
Alignment Health Platinum Select (HMO)
via hydrocodone-ibuprofen 		Tier 2 - Generic — — ✓ 150 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via hydrocodone-ibuprofen 		Tier 2 - Generic — — ✓ 150 per 30 days QL
Alignment Health AVA (PPO)
via hydrocodone-ibuprofen 		Tier 2 - Generic — — ✓ 150 per 30 days QL
AmeriHealth Caritas VIP Care (HMO D-SNP)
via hydrocodone-ibuprofen 		Tier 2 - Generic — — ✓ 150 per 30 days QL
Aetna Medicare Value Plus (HMO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Signature (HMO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Dual (HMO D-SNP)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
HealthSpring Preferred Plus (HMO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 50 per 30 days QL
HealthSpring Preferred Savings (HMO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 50 per 30 days QL
HealthSpring Preferred Select (HMO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 50 per 30 days QL
HealthSpring TotalCare Plus (HMO D-SNP)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 50 per 30 days QL
HealthSpring Preferred (HMO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 50 per 30 days QL
HealthSpring TotalCare (HMO D-SNP)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 50 per 30 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Enhanced (HMO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Full Dual Care (HMO D-SNP)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Signature Care (HMO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Prime (HMO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Signature (HMO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
HealthSpring True Choice (PPO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 50 per 30 days QL
Aetna Medicare Signature (PPO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Signature Giveback (PPO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Signature (PPO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Signature (PPO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Signature Extra (PPO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Enhanced (PPO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Enhanced (PPO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Aetna Medicare Signature (PPO)
via hydrocodone-ibuprofen 		Tier 3 - Preferred Brand — — ✓ 150 per 30 days QL
Healthy Blue + Medicare (HMO-POS D-SNP)
via hydrocodone-ibuprofen 		Tier 4 - Non-Preferred — — ✓ 150 per 30 days QL
Blue Medicare Enhanced (HMO-POS)
via hydrocodone-ibuprofen 		Tier 4 - Non-Preferred — — ✓ 150 per 30 days QL
Blue Medicare Essential Plus (HMO-POS)
via hydrocodone-ibuprofen 		Tier 4 - Non-Preferred — — ✓ 150 per 30 days QL
Blue Medicare PPO Enhanced (PPO)
via hydrocodone-ibuprofen 		Tier 4 - Non-Preferred — — ✓ 150 per 30 days QL
Experience Health Medicare Advantage (HMO)
via hydrocodone-ibuprofen 		Tier 4 - Non-Preferred — — ✓ 150 per 30 days QL
Blue Medicare Essential (HMO)
via hydrocodone-ibuprofen 		Tier 4 - Non-Preferred — — ✓ 150 per 30 days QL
Blue Medicare Choice (HMO)
via hydrocodone-ibuprofen 		Tier 4 - Non-Preferred — — ✓ 150 per 30 days QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via hydrocodone-ibuprofen 		Non-Preferred ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 12 hours, 49 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via hydrocodone-ibuprofen 		Tier 2 - Non-Preferred Generic ✓ — ✓ PA | QL
NC State Health Plan - 70/30 Standard PPO 2026
via hydrocodone-ibuprofen 		Tier 2 - Non-Preferred Generic ✓ — ✓ PA | QL
NC State Health Plan - HDHP 2026
via hydrocodone-ibuprofen 		Tier 2 - Non-Preferred Generic ✓ — ✓ PA | QL
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