Lithostat
Generic: acetohydroxamic acid
250 Mg — Tablet
Also known as:
LITHOSTAT TABS 250MG
Lithostat 250 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 plansBlue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Local 2026 | Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
| BCBSNC Blue Care 2026 | Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
| BCBSNC Blue Value 2026 | Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
| BCBSNC Blue Advantage 2026 | Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 4 - Higher Cost Brand | — | — | — Restricted Access | None |
Cigna
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 80/20 Plus PPO 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Not Covered | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Not Covered | — | — | — | None |