mannitol

20%, 25% — Solution

DIAGNOSTIC AGENTS

Also known as: mannitol soln 20%, 25% BRONCHITOL MANNITOL SOLN 20%, 25% mannitol soln 25%

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic None
Elite Bronze + Vision + Adult Dental Tier 2 - Generic None
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic None
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic None
Focused Silver with Atrium Health + Vision + Adult Dental Tier 2 - Generic None
Complete Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic None
Standard Expanded Bronze + Vision + Adult Dental Tier 2 - Generic None
Standard Silver + Vision + Adult Dental Tier 2 - Generic None
Standard Gold + Vision + Adult Dental Tier 2 - Generic None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 2 - Generic None
Standard Expanded Bronze with Atrium Health Tier 2 - Generic None
Standard Silver with Atrium Health Tier 2 - Generic None
Standard Gold with Atrium Health Tier 2 - Generic None
Standard Gold with Atrium Health + Vision + Adult Dental Tier 2 - Generic None
Complete Gold Tier 2 - Generic None
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 2 - Generic None
Everyday Bronze Tier 2 - Generic None
Elite Bronze Tier 2 - Generic None
Clear Silver with $0 Insulin Options Tier 2 - Generic None
Standard Expanded Bronze Tier 2 - Generic None
Standard Silver Tier 2 - Generic None
Standard Gold Tier 2 - Generic None
Everyday Bronze with Atrium Health Tier 2 - Generic None
Elite Bronze with Atrium Health Tier 2 - Generic None
Focused Silver with Atrium Health Tier 2 - Generic None
Complete Gold with Atrium Health Tier 2 - Generic None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 2 - Generic None
Complete Gold + Vision + Adult Dental Tier 2 - Generic None
Everyday Bronze + Vision + Adult Dental Tier 2 - Generic None
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via Bronchitol
Tier 5 - Non-Preferred Specialty PA
BCBS Federal Basic Option 2026
via Bronchitol
Tier 5 - Non-Preferred Specialty PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 17 hours, 18 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
NC State Health Plan - 80/20 Plus PPO 2026
via Bronchitol
Not Covered None
NC State Health Plan - 70/30 Standard PPO 2026
via Bronchitol
Not Covered None
NC State Health Plan - HDHP 2026
via Bronchitol
Not Covered None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 17 hours, 18 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary PA
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