tablet

100-150 mg, 133-200 mg — Tablet

Opioid Analgesics, Short-acting

Also known as: tablet 10-325 mg, 2 .5-325 mg, 5-325 tablet 100-150 mg, 133-200 mg tablet 200-300 mg tablet 10 mg, 5 mg l is d e x a mfetamine dimesylate oral tablet extended release pyridostigmine bromide oral tablet extended release 18 mg, 27

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: Jan 1, 2026  ·  Checked: 20 hours, 45 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UnitedHealthcare NC Individual & Family 2026 Unknown PA | QL
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