levalbuterol tartrate

45 mcg/actuation — Inhaler

Also known as: LEVALBUTEROL TARTRATE HFA XOPENEX HFA

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

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 19 hours, 15 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026 via Levalbuterol Tartrate Hfa	Tier 1 - Generic	—	—	✓	QL

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 19 hours, 15 minutes ago

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

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 19 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	✓	QL