Hyoscyamine

0.125 Mg — Tablet

Also known as: Hyoscyamine 0.125 Mg Odt Tablet Hyoscyamine 0.125 Mg/5 Ml Elixir Hyoscyamine 0.125 Mg/Ml Oral Drops Hyoscyamine 0.125 Mg Sublingual Tablet Hyoscyamine 0.125 Mg Tablet Hyoscyamine Er 0.375 Mg Tablet

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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.

Blue Cross Blue Shield Federal

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026 via Levsin	Tier 3 - Non-Preferred Brand	—	—	—	None
BCBS Federal Basic Option 2026 via Levsin	Tier 3 - Non-Preferred Brand	—	—	—	None

Cigna

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 22 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 1 - Generic	—	—	—	None

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 9 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 via Levsin	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Levsin	Tier 3 - Non-Preferred Brand	—	—	—	None
NC State Health Plan - HDHP 2026 via Levsin	Tier 3 - Non-Preferred Brand	—	—	—	None