sod sulfate-pot sulf-mg sulf
177ml — Tablet
Also known as:
sod sulfate-pot sulf-mg sulf oral sol 17.5-3.13-1.6 gm/177ml
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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.
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Standard Option 2026
via sod sulfate-pot sulf-mg sulf oral |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via sod sulfate-pot sulf-mg sulf oral |
Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Focus 2026
via sod sulfate-pot sulf-mg sulf oral |
Tier 1 - Generic | — | — | — | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Care 2026
via Suprep Bowel Prep Ki |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Value 2026
via Suprep Bowel Prep Ki |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Advantage 2026
via Suprep Bowel Prep Ki |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Suprep Bowel Prep Ki |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
|
BCBSNC Blue Local 2026
via Suprep Bowel Prep Ki |
Tier 2 - Medium Cost Generic/Brand | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via sod sulfate-pot sulf-mg sulf oral |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via sod sulfate-pot sulf-mg sulf oral |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via sod sulfate-pot sulf-mg sulf oral |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |