levoleucovorin calcium

175mg/17.5ml, 250mg/25ml — Solution

Folate Analog

Also known as: levoleucovorin calcium soln 175mg/17.5ml, 250mg/25ml; solr 50mg levoleucovorin calcium soln 175mg/17.5ml,
GoodRx Compare Prices

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: 20 hours, 51 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - 70/30 Standard PPO 2026 Tier 4 - Specialty Generic ✓ — — PA
NC State Health Plan - HDHP 2026 Tier 4 - Specialty Generic ✓ — — PA
Something not right?