omeprazole-sodium bicarbonate powd pack for

1680 mg — Suspension

ULCER THERAPY COMBINATIONS

Also known as: omeprazole-sodium bicarbonate powd pack for susp 20-1680 mg omeprazole-sodium bicarbonate powd pack for susp 40-1680 mg

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 14 hours, 28 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026 Tier 1 - Generic QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 14 hours, 28 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
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