Motofen
Generic: atropine sulfate
0.025 MG — Tablet
Also known as:
MOTOFEN TAB 1-0.025
atropine sulfate
Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Ambetter (Centene)
58 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Everyday Bronze
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold | Tier 4 - Non-Preferred | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze | Tier 4 - Non-Preferred | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Focused Silver with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 4 - Non-Preferred | — | — | — | None |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
2 plansCigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Bronze 5500 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Silver
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 2200 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold 1500 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect myDiabetesCare Bronze
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 6000 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3500 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD 5000 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 3500 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 4400 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD 5000 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver 3000 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze 6500 Indiv Med Deductible
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver CMS Standard
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Silver RD CMS Standard
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold CMS Standard
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze RD CMS Standard
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Gold RD CMS Standard
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Connect Bronze CMS Standard
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
Medicare Part D
37 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Longevity Health Plan (HMO I-SNP)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via atropine sulfate |
Tier 2 - Generic | ✓ | — | — | PA |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via atropine sulfate |
Tier 2 - Generic | ✓ | — | — | PA |
|
Troy Medicare (HMO)
via atropine sulfate |
Tier 2 - Generic | ✓ | — | — | PA |
|
HealthSpring TotalCare (HMO D-SNP)
via atropine sulfate |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via atropine sulfate |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring True Choice (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring Preferred (HMO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Simple Open (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via atropine sulfate |
Tier 4 - Non-Preferred | — | — | — | None |
NC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - HDHP 2026
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 3 - Non-Preferred Brand | — | — | — | None |
| 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 |
Oscar Health
56 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Gold Classic Standard
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic Standard | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Gold Classic Standard | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Secure
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic 4700
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple PCP Saver
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Gold Elite Saver Plus
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Diabetes
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Secure | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic 4700 | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Diabetes | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple PCP Saver | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Gold Elite Saver Plus | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Diabetes | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Chronic Care CKM | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AIAN Cost Share
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
AIAN Cost Share | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic Standard
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic Standard
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic Standard | with Atrium Health
via atropine sulfate |
Tier 2 - Generic | — | — | — | None |
| Silver Simple PCP Saver | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| AIAN Cost Share | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Diabetes | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Secure | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Diabetes | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Elite Saver Plus | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple PCP Saver | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic 4700 | Tier 4 - Non-Preferred | — | — | — | None |
| Secure | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Diabetes | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
UnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Standard (No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Standard (No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Standard (No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via atropine sulfate |
Tier 1 - Preferred Generic | — | — | — | None |