omeprazole/sodium bicarbonate

20 mg-1,680 mg, 20 mg-1.1 gram, 40 mg-1,680 mg, 40 mg-1.1 gram — Capsule

Also known as: ZEGERID OMEPRAZOLE-SODIUM BICARBONATE

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

10 plans

Source: CMS QHP JSON · Checked: 18 hours, 21 minutes ago

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

1 plan

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 18 hours, 21 minutes ago

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

6 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 18 hours, 21 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 via omeprazole-sodium bicarbonate	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via omeprazole-sodium bicarbonate	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via omeprazole-sodium bicarbonate	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

1 plan

Source: Excel (XLSX) · Formulary date: Jun 24, 2026 · Checked: 18 hours, 21 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA