Levsin

Generic: hyoscyamine

125MG — Tablet

Also known as: LEVSIN TABS .125MG

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: Jul 1, 2026 · Checked: 12 hours, 41 minutes ago

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

Cigna

20 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 12 hours, 41 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect Bronze CMS Standard via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Gold CMS Standard via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Bronze RD CMS Standard via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Gold RD CMS Standard via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Silver via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Silver RD 2200 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Gold 1500 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect myDiabetesCare Bronze via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Bronze 5500 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 6000 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Silver 3500 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Bronze RD 5000 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Silver RD 3500 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Bronze 7000 HSA Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Silver 4400 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Silver RD 5000 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Silver 3000 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Bronze 6500 Indiv Med Deductible via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Silver CMS Standard via Hyoscyamine	Tier 2 - Generic	—	—	—	None
Connect Silver RD CMS Standard via Hyoscyamine	Tier 2 - Generic	—	—	—	None

NC State Health Plan

3 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 12 hours, 41 minutes ago

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