Sulfatrim
Generic: sulfamethoxazole
40 MG — Suspension
Also known as:
sulfamethoxazole
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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.
Ambetter (Centene)
58 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Standard Expanded Bronze | Tier 2 - Generic | — | — | — | None |
| Standard Silver | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
|
Complete Gold
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Complete Gold | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze | Tier 2 - Generic | — | — | — | None |
| Elite Bronze | Tier 2 - Generic | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Silver Classic | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic Standard
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Gold Classic Standard
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic Standard | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic Standard | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Gold Classic Standard | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Silver Classic
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Secure
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic 4700
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple PCP Saver
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Gold Elite Saver Plus
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Diabetes
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Secure | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic 4700 | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Diabetes | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple PCP Saver | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Gold Elite Saver Plus | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Bronze Simple Diabetes | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Chronic Care CKM | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AIAN Cost Share
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
AIAN Cost Share | with Atrium Health
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
|
Bronze Classic Standard
via sulfamethoxazole |
Tier 2 - Generic | — | — | — | None |
UnitedHealthcare
26 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Standard (No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Standard+ Dental + Vision (No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Value ($0 Virtual Urgent Care, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
| UHC Bronze Standard (No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) | Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Standard (No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Standard (No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via sulfamethoxazole |
Tier 1 - Preferred Generic | — | — | — | None |