omeprazole-sodium bicarbonate

Generic: omeprazole/sodium bicarbonate

1100 mg — Capsule

Also known as: omeprazole-sodium bicarbonate cap 20-1100 mg omeprazole-sodium bicarbonate cap 40-1100 mg omeprazole-sodium bicarbonate cap 20-1100 omeprazole-sodium bicarbonate cap 40-1100 Omeprazole-Sodium Bicarbonate Oral Capsule Omeprazole-Sodium Bicarbonate Oral Packet

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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.

AmeriHealth Caritas NC

10 plans

Source: CMS QHP JSON · Checked: 2 hours, 19 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Tier 2 - Generic	—	✓	—	ST
AmeriHealth Caritas Next Bronze Premier + No Referrals	Tier 2 - Generic	—	✓	—	ST
AmeriHealth Caritas Next Gold Premier + No Referrals	Tier 2 - Generic	—	✓	—	ST
AmeriHealth Caritas Next Bronze Essential + No Referrals	Tier 2 - Generic	—	✓	—	ST
AmeriHealth Caritas Next Gold Signature + No Referrals	Tier 2 - Generic	—	✓	—	ST
AmeriHealth Caritas Next Silver Essential + No Referrals	Tier 2 - Generic	—	✓	—	ST
AmeriHealth Caritas Next Bronze Signature + No Referrals	Tier 2 - Generic	—	✓	—	ST
AmeriHealth Caritas Next Silver Signature + No Referrals	Tier 2 - Generic	—	✓	—	ST
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Tier 2 - Generic	—	✓	—	ST
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 2 - Generic	—	✓	—	ST

Blue Cross Blue Shield Federal

1 plan

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 2 hours, 19 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Standard Option 2026	Tier 1 - Generic	—	—	✓	QL

NC Medicaid PDL

1 plan

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 2 hours, 19 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via omeprazole-sodium bicarbonate capsule / packet	Non-Preferred	—	✓	—	ST

NC State Health Plan

6 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 2 hours, 19 minutes ago

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
NC State Health Plan - 80/20 Plus PPO 2026 via Zegerid	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Zegerid	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Zegerid	Not Covered	—	—	—	None

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jun 24, 2026 · Checked: 2 hours, 19 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via omeprazole/sodium bicarbonate	Tier 3 - Non-Formulary	✓	—	—	PA