Tetracycline

250 Mg — Capsule

Also known as: Sumycin Tetracycline 250 Mg Capsule Tetracycline 500 Mg Capsule

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

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 20 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026	Tier 2 - Preferred Brand	—	—	—	None

1 plan

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 20 hours, 39 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	—	—	None