methadone hydrochloride i conc

Generic: methadone hydrochloride i conc 10mg/ml

10mg

Also known as: methadone hydrochloride i conc 10mg/ml Methadone Hydrochloride I Conc 10mg/ml

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 9 hours, 36 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	✓	✓	✓	PA \| ST \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	✓	✓	✓	PA \| ST \| QL
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	✓	✓	✓	PA \| ST \| QL