levetiracetam in sodium chloride iv

1000 mg/100ml — Solution

0.9%

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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: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 22 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 1 - Preferred Generic None
NC State Health Plan - 70/30 Standard PPO 2026 Tier 1 - Preferred Generic None
NC State Health Plan - HDHP 2026 Tier 1 - Preferred Generic None
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